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2017 ; 22
(ä): 11-14
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Chronic eosinophilic pneumonia: Adjunctive therapy with inhaled steroids
#MMPMID28626631
Chan C
; DeLapp D
; Nystrom P
Respir Med Case Rep
2017[]; 22
(ä): 11-14
PMID28626631
show ga
Idiopathic chronic eosinophilic pneumonia (ICEP) is a rare form of diffuse
parenchymal lung disease first identified by Carrington et al. in 1969. It is
characterized by the presence of constitutional and respiratory symptoms with
associated peripheral opacities on imaging and elevated serum and/or
bronchoalveolar eosinophilia. Although data is limited regarding etiology or
prevalence, it is known that ICEP has a 2:1 female: male predominance and
typically affects non-smokers. Diagnosis rests on the clinical constellation of
respiratory symptoms of at least 2-4 weeks duration, the presence of diffuse
pulmonary alveolar consolidation, classically described as the "photographic
negative of pulmonary edema", the presence of eosinophils ?40% on bronchoalveolar
lavage or ?1000/mm(3) eosinophils on peripheral blood and the exclusion of other
known causes of eosinophilic lung diseases such as drugs, toxins, fungi,
parasites, and collagen-vascular disorders. A dramatic response is achieved with
systemic corticosteroids, which is typically dosed over 6 months to 1 year.
Despite this response, approximately 30-50% of patients will relapse upon
cessation of steroids or during the taper. Although these patients respond well
to another trial of steroids, the side effects of long term steroids are well
known, including osteoporosis, diabetes, hypertension and cataracts. Inhaled
corticosteroids as monotherapy has been trialed in the past without success.
However, we report a case of a patient who underwent treatment with systemic
corticosteroids followed by inhaled steroids who has remained in remission for 2
years.