Chronic Eosinophilic PneumoniaChronic Eosinophilic Pneumonia

As Presented by Brett W. As Presented by Brett W. Baskovich…Baskovich…

What is it?What is it?

• PneumoniaPneumonia• EosinophilicEosinophilic• ChronicChronic

Causes of Eosinophilic PneumoniaCauses of Eosinophilic Pneumonia

• Churg-Strauss SyndromeChurg-Strauss Syndrome• Allergic Bronchopulmonary AspergillosisAllergic Bronchopulmonary Aspergillosis• Medications/Drugs/ToxinsMedications/Drugs/Toxins– Nitrofurantoin, ampicillin, ibuprofen, naproxen, Nitrofurantoin, ampicillin, ibuprofen, naproxen,

phenytoin, sulfasalazine, tetracyclinephenytoin, sulfasalazine, tetracycline

• Parasites- Löffler's syndromeParasites- Löffler's syndrome

SymptomsSymptoms

• CoughCough• FeverFever• Shortness of breathShortness of breath• Night sweatsNight sweats• WheezingWheezing• Weight lossWeight loss

DiagnosisDiagnosis

• Typically made 7 mo. after sx beginTypically made 7 mo. after sx begin• Bronchoalveolar lavageBronchoalveolar lavage

TreatmentTreatment

• Option 1: SteroidsOption 1: Steroids

TreatmentTreatment

• Prednisone 40 – 60 mg/dayPrednisone 40 – 60 mg/day– Continue until Sx and CXR resolved (4-6 weeks)Continue until Sx and CXR resolved (4-6 weeks)– Cut dose in half (8 weeks)Cut dose in half (8 weeks)– Reduce by 5 mg every 4 weeksReduce by 5 mg every 4 weeks

TreatmentTreatment

• Maintain patient on minimum possible doseMaintain patient on minimum possible dose• Switch to alternate-day prednisoneSwitch to alternate-day prednisone• Add inhaled corticosteroidsAdd inhaled corticosteroids

TreatmentTreatment

• High-dose inhaled corticosteroidHigh-dose inhaled corticosteroid– Beclometasone dipropionate 1,600 mcg/dayBeclometasone dipropionate 1,600 mcg/day

ReferencesReferences• Chronic eosinophilic pneumonia complicated by bronchial asthma and

diabetes mellitus successfully treated with suplatast tosilate and high-dose inhaled corticosteroid therapy. Fujimori K, Shimatsu Y et al. Nihon Kokyuki Gakkai Zasshi. 1999 Nov;37(11):903-8.

• Chronic eosinophilic pneumonia: treatment with inhaled corticosteroids. Minakuchi M, Niimi A et al. Respiration. 2003 Jul-Aug;70(4):362-6.

• Eosinophilic lung diseases: a clinical, radiologic, and pathologic overview. Jeong YJ, Kim KI et al. Radiographics. 2007 May-Jun;27(3):617-37; discussion 637-9.

• Chronic eosinophilic pneumonia. Edwards LT, Fulmer JM et al. BUMC Proceedings. 1999;12:67-74.

• Chronic eosinophilic pneumonia: a review. Alam M, Burki NK. South Med J. 2007 Jan;100(1):49-53.