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Retrospective Case Series of Thirty-Two Patients with Biopsy-Proven Chronic Eosinophilic Pneumonia
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A1677 - Retrospective Case Series of Thirty-Two Patients with Biopsy-Proven Chronic Eosinophilic Pneumonia
Author Block: A. Rajaratnam1, J. Tso1, F. Shah2; 1Internal Medicine, University of Pittsburgh Medical Center, McKeesport, PA, United States, 2Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, United States.
Introduction: Chronic eosinophilic pneumonia (CEP) is a rare disorder with an incidence of less than 1 per 100 thousand that is characterized by pulmonary eosinophilia, migratory opacities on chest imaging, and responsiveness to corticosteroids. CEP is often diagnosed with clinical history and bronchoalveolar lavage or with lung biopsy, with the latter reserved typically for cases of diagnostic uncertainty. In this study, we present the first case series of patients specifically with biopsy-proven CEP. Methods: Study design was approved by a local institutional review board. Initial screen consisted of natural language case search for ""eosinophilic pneumonia"" among lung biopsy diagnoses from 1998 to 2016 at a single tertiary-care center in Pittsburgh. Further review of pathology reports and electronic medical record identified cases of CEP after excluding alternate causes of eosinophilic and non-eosinophilic lung disease. Demographics, past medical history, medication use, laboratory and imaging results, and spirometry data prior to lung biopsy were collected for cases of CEP. Data are reported as median [interquartile range]. Results: Initial screen yielded 263 cases of eosinophilic pneumonia and subsequent review identified 32 patients with biopsy-proven CEP. Median age at time of biopsy was 53 years [43, 64]. Patients were primarily Caucasian (91%) with no significant gender predominance(53% female, 47% male). Thirty-eight percent reported ongoing tobacco use. In the week prior to biopsy, 41% received oral corticosteroids and 38% received antibiotics. Peripheral eosinophilia was mild at 3% total blood count [0.2, 8]. Patients had radiographic evidence of involvement of a median of 3 distinct lung lobes [2, 6] prior to biopsy. Interestingly, only 34% reported a pre-existing history of asthma with a low prevalence of obstruction on spirometry (median FEV1/FVC 73% [70, 77], although median FEF (25-75) was reduced at 60% [43, 75]. Conclusion: In our cohort of patients with biopsy-proven CEP, patients were older, reported a lower prevalence of asthma, and had milder obstructive disease than previously reported studies of CEP.
Author Block: A. Rajaratnam1, J. Tso1, F. Shah2; 1Internal Medicine, University of Pittsburgh Medical Center, McKeesport, PA, United States, 2Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, United States.
Introduction: Chronic eosinophilic pneumonia (CEP) is a rare disorder with an incidence of less than 1 per 100 thousand that is characterized by pulmonary eosinophilia, migratory opacities on chest imaging, and responsiveness to corticosteroids. CEP is often diagnosed with clinical history and bronchoalveolar lavage or with lung biopsy, with the latter reserved typically for cases of diagnostic uncertainty. In this study, we present the first case series of patients specifically with biopsy-proven CEP. Methods: Study design was approved by a local institutional review board. Initial screen consisted of natural language case search for ""eosinophilic pneumonia"" among lung biopsy diagnoses from 1998 to 2016 at a single tertiary-care center in Pittsburgh. Further review of pathology reports and electronic medical record identified cases of CEP after excluding alternate causes of eosinophilic and non-eosinophilic lung disease. Demographics, past medical history, medication use, laboratory and imaging results, and spirometry data prior to lung biopsy were collected for cases of CEP. Data are reported as median [interquartile range]. Results: Initial screen yielded 263 cases of eosinophilic pneumonia and subsequent review identified 32 patients with biopsy-proven CEP. Median age at time of biopsy was 53 years [43, 64]. Patients were primarily Caucasian (91%) with no significant gender predominance(53% female, 47% male). Thirty-eight percent reported ongoing tobacco use. In the week prior to biopsy, 41% received oral corticosteroids and 38% received antibiotics. Peripheral eosinophilia was mild at 3% total blood count [0.2, 8]. Patients had radiographic evidence of involvement of a median of 3 distinct lung lobes [2, 6] prior to biopsy. Interestingly, only 34% reported a pre-existing history of asthma with a low prevalence of obstruction on spirometry (median FEV1/FVC 73% [70, 77], although median FEF (25-75) was reduced at 60% [43, 75]. Conclusion: In our cohort of patients with biopsy-proven CEP, patients were older, reported a lower prevalence of asthma, and had milder obstructive disease than previously reported studies of CEP.
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