Dilemma of Eosinophilic Pneumonia in Children

E. A. Dominguez Silveyra1, M. B. Pirzada2, C. Valsamis3, C. Halaby4, A. Webb1;

Author address: 

1Pediatric Pulmonology, NYUWinthrop Hospital, Mineola, NY, United States, 2Pediatrics Pulmonology, NYUWinthrop Hospital, Old Westbury, NY, United States, 3Pediatric Pulmonology, NYUWinthrop Hospital, Merrick, NY, United States, 4Pediatric Pulmonology, NYUWinthrop Hospital, Manhasset, NY, United States.

Abstract: 

Introduction Eosinophilic pneumonia is a rare condition among children, and requires a high index of suspicion. The etiology is broad and can range from simple pulmonary eosinophilia, Löffler’s syndrome, fungal infections, acute eosinophilic pneumonia, chronic eosinophilic pneumonia, Churg-Strauss syndrome, allergic bronchopulmonary aspergillosis, to drug related eosinophilic pneumonia. In most cases, finding the etiology can be a difficult task. Case description 15 year old male with previous history of acne treated for 1 year with minocycline, presented to the hospital with a 1 month of persistent cough, night sweat, fever, and weight loss. He was not in respiratory distress and lung auscultation as well as HbO2 saturations was normal. Patient had a recent history of viral meningitis 2 months prior after traveling to northwest Mexico. Initial blood work showed peripheral eosinophilia, elevated inflammatory markers, negative pANCA, elevated IgE and normal histoplasmosis, aspergillus and toxocara titers. The CXR and the chest CT scan revealed bilateral ground glass opacifications more prominent on the left side, mediastinal lymphadenopathy and a small pericardial effusion. Flexible bronchoscopy with BAL showed 45% eosinophilia and negative cultures for bacteria, mycobacterium, fungus and parasites. Patient underwent a video assisted thoracoscopic surgery and the biopsy showed desquamative interstitial pneumonitis, without evidence of malignancy. At this point patient was started on systemic steroids. Once patient’s Coccidioides complement fixation antibody result was positive on day 3 of steroids, the management was changed from steroids to Itraconazol. Patient responded well to the treatment with resolution of the symptoms and imaging findings. Discussion of the novelty and importance of this specific case We present a case of eosinophilic pneumonia with multiple possible etiologies, from Löffler’s syndrome/ Parasitic infection or fungal infection due to recent travel history to endemic area, chronic eosinophilic pneumonia, and drug related eosinophilic pneumonia due to use of minocycline. The initial presentation of insidious cough, night sweats, weight loss, with peripheral eosinophilia and BAL with 45% Eosinophil, ESR/CRP elevation, IgE elevation and the chest CT finding of ground glass attenuation, and mediastinal lymphadenopathy, without any initial finding of infectious etiology was consistent with chronic eosinophilic pneumonia, but the later finding for Coccidioides complement fixation antibody, direct us to the final diagnosis of Coccidioidomycosis infection. Prompt diagnosis of the eosinophilic pneumonia etiology is essential in order to implement a proper management.

Tables: 

2018

abstract No: 

A7826

Full conference title: 

The American Thoracic Society Conference 2018
    • ATS 2018