Pulmonary infiltration with eosinophilia: a clinical analysis of forty-eight cases_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

SHI Xu , HUANG Xiafei , XIE Jiaxing , ZHANG Qingling , XIAN Mo , YANG Zhaowei , GU Yingying , GUAN Yubao ,  LI Jing

Department of Allergy and Clinical Immunology, Guangzhou Institute of Respiratory Disease, State Key Laboratory of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, 510120, China;

Corresponding author：

LI Jing, Email: jingli1016@vip.163.com

Keywords：

Pulmonary infiltration with eosinophilia; Allergic broncho pulmonary aspergillosis; Eosinophilic granulomatosis with polyangiitis

DOI：

10.7507/1671-6205.201606021

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Objective To improve the diagnosis and treatment of pulmonary infiltration with eosinophilia (PIE). Methods Patients who were diagnosed with PIE in the First Affiliated Hospital of Guangzhou Medical University from January 2004 to December 2013 were recruited and retrospectively analyzed. Data of etiology, clinical manifestation, imaging and pathological features were recorded. Results pulmonary eosinophilic granuloma (PEG) (n=2), eosinophilic granulomatosis with polyangiitis (EGPA) (n=7), Löffler syndrome (n=4), allergic bronchopulmonary aspergillosis (ABPA) (n=16), and chronic eosinophilic pneumonia (CEP) (n=19). There were 27 males and 21 females. 47.9% of the PIE patients were diagnosed as asthma and treated with regular treatment but had not been controlled well. PEG was characterized with wheeze and anhelation in clinical manifestations, unelevated blood eosinophil counts and percentage, significant small airway abnormalities in lung function, diffuse pneumonectasis in Chest CT, and appearance of eosinophil cells in alveole. EGPA shows dyspnea and cough in clinical manifestations, as well as other organs function damaged, unelevated blood eosinophil counts and percentage, significant FEV₁/FVC and small airway abnormalities in lung function, tree-in-bud in Chest CT, appearance of eosinophilic granuloma outside blood vessels. Löffler syndrome also showed cough, shorter course of disease, normal lung function and diffusion. ABPA showed wheeze and cough, 31.3% of them with hemoptysis, normal blood eosinophil count, central bronchiectasis in Chest CT. CEP also showed dyspnea and cough. 21.1% of CEP patientshad chest pain, increasing sputum eosinophil percentage compare with blood eosinophil percentage, and small airway abnormalities in lung function. Conclusions Most of PIE patients are diagnosed as asthma but haven’t gotten well controlled under the regular anti-asthmatic treatment. Patients with PIE have increasing eosinophil counts and decreasing lung function. The diagnosis of PIE still depends on clinical manifestation, laboratory test, imaging and pathological examination.

Citation： SHI Xu, HUANG Xiafei, XIE Jiaxing, ZHANG Qingling, XIAN Mo, YANG Zhaowei, GU Yingying, GUAN Yubao, LI Jing. Pulmonary infiltration with eosinophilia: a clinical analysis of forty-eight cases. Chinese Journal of Respiratory and Critical Care Medicine, 2017, 16(2): 147-154. doi: 10.7507/1671-6205.201606021 Copy

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1. Davidsen JR, Madsen PH, Laursen CB. Uncontrolled asthma and recurring pulmonary opacities: just asthma?. BMJ Case Rep, 2014. pii: bcr2013202428.
2. Tan SK, Liu TT. Cutaneous larva migrans complicated by Loffler syndrome. Arch Dermatol, 2010, 146(2): 210-212.
3. Suri HS, Yi ES, Nowakowski GS, et al. Pulmonary Langerhans cell histiocytosis. Orphanet J Rare Dis, 2012, 7: 16.
4. Kolb AG, Ives ST, Davies SF. Diagnosis in just over a minute: a case of chronic eosinophilic pneumonia. J Gen Intern Med, 2013, 28(7): 972-975.
5. Mou Y, Ye L, Ye M, et al. A retrospective study of patients with a delayed diagnosis of allergic bronchopulmonary aspergillosis/allergic bronchopulmonary mycosis. Allergy Asthma Proc, 2014, 35(2): e21-26.
6. Koren Fernández L, Alonso Charterina S, Alcalá-Galiano Rubio A, et al. The different manifestations of pulmonary aspergillosis: multidetector computed tomography findings. Radiologia, 2014, 56(6): 496-504.
7. 吉连梅, 贺玲玲, 赵东宝. 嗜酸性肉芽肿性多血管炎23例临床分析. 中华风湿病学杂志, 2015, 19(2): 102-105.
8. Wei P, Lu HW, Jiang S, et al. Pulmonary Langerhans cell histiocytosis: case series and literature review. Medicine, 2014, 93(23): e141.
9. Durel CA, Berthiller J, Caboni S, et al. Long-term follow-up of a multicentre cohort of 101 patients with eosinophilic granulomatosis with polyangiitis (EGPA). Arthritis Care Res, 2015, 68(3): 374-387.

Chinese Journal of Respiratory and Critical Care Medicine

Pulmonary infiltration with eosinophilia: a clinical analysis of forty-eight cases

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