Idiopathic acute eosinophilic pneumonia
- Talmadge E King, Jr, MD
Talmadge E King, Jr, MD
- Editor-in-Chief — Pulmonary and Critical Care Medicine
- Section Editor — Interstitial Lung Disease
- Dean, School of Medicine
- Vice Chancellor, Medical Affairs
- University of California San Francisco
Idiopathic acute eosinophilic pneumonia (AEP) was first described as a cause of acute respiratory failure in 1989 [1,2]. Subsequently, cases of AEP have been reported worldwide [3-6]. Although both AEP and chronic eosinophilic pneumonia (CEP) are characterized by eosinophilic infiltration of the pulmonary parenchyma, these disorders are clinically distinct . (See "Chronic eosinophilic pneumonia".)
The clinical features and management of idiopathic acute eosinophilic pneumonia will be reviewed here. Other conditions associated with pulmonary eosinophilia and the approach to adults with diffuse parenchymal lung disease are presented separately (table 1). (See "Causes of pulmonary eosinophilia" and "Chronic eosinophilic pneumonia" and "Approach to the adult with interstitial lung disease: Clinical evaluation" and "Approach to the adult with interstitial lung disease: Diagnostic testing".)
The cause of acute eosinophilic pneumonia (AEP) remains unknown. Some investigators have suggested that AEP is an acute hypersensitivity reaction to an unidentified inhaled antigen in an otherwise healthy individual . The following observations are consistent with this hypothesis:
●In several reports, patients have been involved in unusual outdoor activities just prior to the onset of their illness [1,8-10]. As an example, AEP developed in at least one firefighter following the collapse of the World Trade Center towers in 2001 . Another case developed in a young male smoker after he inhaled smoke from fireworks for three consecutive nights .
●A temporal relationship has been described in a number of patients between the development of AEP and the recent onset of cigarette smoking (for the first time or following a period of smoking cessation) [8,12-24]. In one patient, a cigarette-smoking challenge test led to recurrence of eosinophilic pneumonia . In contrast, the process resolved in another patient despite continued cigarette smoking . An association between passive smoking and AEP has also been reported .
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