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A4793 - Acute Eosinophilic Pneumonia in the Setting of Hypogammaglobulinemia
Author Block: A. Nikamal1, R. Ali1, Z. Hussain1, M. M. Rachid2; 1UIC/Advocate Christ Medical Center, Oak Lawn, IL, United States, 2Internal Medicine, UIC/Advocate Christ Medical Center, Oak Lawn, IL, United States.
Introduction:
Acute Eosinophilic Pneumonia (AEP) is a rare, life threatening, condition mistaken for infectious pneumonia. AEP presents with severe respiratory distress and diffuse infiltrates on chest X-Ray. We present a case of AEP in the setting of hypogammaglobinemia.
Case:
18-year-old female with PMH of uncomplicated premature birth presented with fever, rash, sore throat and dyspnea for 1 week. Desquamating rash began on hands, feet and spread to legs and trunk. She had two younger sisters who presented with similar rash and sore throat 1-week prior. Patient and her siblings had been started on Keflex, as outpatient, due to an amoxicillin allergy. Patient noticed swelling of lips, tongue, hands and feet after starting therapy.
At time of presentation, patient was febrile, tachycardic, tachypneic, hypoxic, and hypotensive within a few hours. CBC showed elevated absolute eosinophil count without leukocytosis. Chest X-Ray showed diffuse interstitial infiltrates and small bilateral effusions. Patient and siblings were Group A strep positive.
Patient was on BiPAP and transferred to the MICU. Ceftriaxone and Azithromycin were started for strep pneumonia. Hypoxia worsened and patient was intubated. Patient was extubated on Prednisone therapy. She was discharged home without steroids and with outpatient pulmonology follow up.
Two days after discharge, patient was visiting her sister in the PICU when she became dyspneic. Patient was intubated. Chest CT showed bilateral parenchymal alveolar areas of consolidation in subapices. Patient was prone positioned and treated with steroids. Bronchoalveolar lavage showed elevated eosinophils. Immunology was consulted for both the patient and her siblings in PICU. They were both found to have hypogammaglobinemia.
Discussion
Etiology of Acute Eosinophilic Pneumonia is largely unknown. Risk factors include environmental factors, cigarette smoking or unusual outdoor activity. Patients are usually HIV positive. There have not been many cases of AEP in immunosuppressed states such as hypogammaglobinemia. AEP typically presents in previously healthy individuals with pulmonary symptoms less than a week and is accompanied by fevers, night sweats and pleuritic chest pain. X-ray or CT chest shows diffuse nonperipheral infiltrates. Although, blood eosinophils are normal or mildly elevated, bronchoalveolar lavage shows eosinophils >25%. Most patients are admitted to the ICU and intubated due to the acuity and severity of symptoms. Patients that do not have an obvious cause of AEP, immune work up is warranted. Recovery is typically very fast with steroid treatment and relapse is rare. AEP can be life threatening making early diagnosis imperative to successful treatment.