Exogenous lipoid pneumonia is an uncommon medical condition resulting from aspiration or inhalation of oily material. Generally, lipoid pneumonia has nonspecific clinical and radiological presentations, and may be misdiagnosed as bacterial pneumonia or lung cancer. We describe an unusual case of exogenous lipoid pneumonia accompanied by peripheral blood and pulmonary eosinophilia. A 63-year-old man was admitted with progressively worsening exertional dyspnea and productive cough for 5 days. A chest radiograph showed abnormalities in the lower lobe of the right lung, and a diagnosis of community-acquired pneumonia was made; intravenous antibiotics were administered. However, dyspnea and hypoxia gradually worsened and peripheral blood eosinophilia developed. A bronchoscopy was performed and bronchoalveolar lavage fluid analysis showed markedly increased numbers of eosinophils (40%). Subsequently, a comprehensive review of history revealed that he fell asleep with camellia oil in his mouth for 2 weeks to relieve foreign body sensation of the throat. Sputum and bronchoalveolar lavage fluid cytology showed the presence of lipid-laden macrophages. He was diagnosed with lipoid pneumonia and acute eosinophilic pneumonia. Chest radiograph and symptom were rapidly improved after treatment with intravenous methylprednisolone.
Anoxia ; Anti-Bacterial Agents ; Bronchoalveolar Lavage Fluid ; Bronchoscopy ; Camellia ; Cough ; Diagnosis ; Dyspnea ; Eosinophilia ; Eosinophils* ; Foreign Bodies ; Humans ; Inhalation ; Lung ; Lung Neoplasms ; Macrophages ; Methylprednisolone ; Middle Aged ; Mouth ; Pharynx ; Pneumonia* ; Pneumonia, Bacterial ; Pneumonia, Lipid ; Pulmonary Eosinophilia* ; Radiography, Thoracic ; Respiratory Aspiration ; Sensation ; Sputum

BACKGROUND: Allergic bronchopulmonary aspergillosis (ABPA) in children with asthma, not associated with cystic fibrosis, is yet to receive the recognition it deserves. OBJECTIVE: To highlight the presentation of ABPA in children with asthma. METHODS: This retrospective review documents the occurrence of pediatric ABPA over a period of 31 years in one unit. Children with asthma, eosinophilia and infiltrates on chest radiograph were screened for ABPA. In these patients, demonstration of immediate hypersensitivity response against Aspergillus species along with serological profile and pulmonary function testing were done. Bronchography/computed tomography (CT) of the chest demonstrated central bronchiectasis (CB). CT of the paranasal sinuses was done in patients with upper airways symptoms. In those suspected with allergic Aspergillus sinusitis (AAS) consent was sought from the parents for the invasive procedure needed for the diagnosis of AAS. RESULTS: Of the 349 patients with ABPA diagnosed, 42 (12.03%) were in the pediatric age group. The mean age on presentation was 12.9 ± 4 years with a male preponderance. All patients had asthma and positive intradermal/skin prick test against Aspergillus species. Ring shadows, the most common radiological presentation, were seen in 28 of 42 patients. Bronchography/CT of the chest demonstrated CB, a feature pathognomic of ABPA, in 32 of 42 patients. High attenuation mucus plugs was observed in 7 of 36 patients while ABPA-seropositive was diagnosed in 10 of 42 patients. On imaging, sinusitis was seen in 20 of 30 patients with upper airways symptoms of whom eight had suspected AAS. Three parents consented for surgery, which confirmed the diagnosis. CONCLUSION: This study highlights the need to evaluate asthmatic children for ABPA as also to exclude AAS.
Aspergillosis, Allergic Bronchopulmonary ; Aspergillus ; Asthma ; Bronchiectasis ; Child ; Cystic Fibrosis ; Diagnosis ; Eosinophilia ; Humans ; Hypersensitivity, Immediate ; Male ; Mucus ; Paranasal Sinuses ; Parents ; Radiography, Thoracic ; Respiratory Function Tests ; Retrospective Studies ; Sinusitis ; Thorax

Acute eosinophilic pneumonia (AEP) is an uncommon inflammatory lung disease, and limited data exist concerning the clinical characteristics and factors that influence its occurrence. We retrospectively reviewed the records of AEP patients treated at Korean military hospitals between January 2007 and December 2013. In total, 333 patients were identified; their median age was 22 years, and all were men. All patients presented with acute respiratory symptoms (cough, sputum, dyspnea, or fever) and had elevated levels of inflammatory markers including median values of 13,185/microL for white blood cell count and 9.51 mg/dL for C-reactive protein. All patients showed diffuse ground glass opacity/consolidation, and most had pleural effusion (n = 265; 80%) or interlobular septal thickening (n = 265; 85%) on chest computed tomography. Most patients had normal body mass index (n = 255; 77%), and only 30 (9%) patients had underlying diseases including rhinitis, asthma, or atopic dermatitis. Most patients had recently changed smoking habits (n = 288; 87%) and were Army personnel (n = 297; 89%).The AEP incidence was higher in the Army group compared to the Navy or Air Force group for every year (P = 0.002). Both the number of patients and patients with high illness severity (oxygen requirement, intensive care unit admission, and pneumonia severity score class > or = III) tended to increase as seasonal temperatures rose. We describe the clinical characteristics of AEP and demonstrate that AEP patients have recently changed smoking habits and work for the Army. There is an increasing tendency in the numbers of patients and those with higher AEP severity with rising seasonal temperatures.
Acute Disease ; Asian Continental Ancestry Group ; C-Reactive Protein/analysis ; Cough/etiology ; Dyspnea/etiology ; Fever/etiology ; Humans ; Incidence ; Leukocyte Count ; Male ; Military Personnel ; Pleural Effusion/complications/diagnosis/radiography ; Pulmonary Eosinophilia/complications/*diagnosis/pathology ; Republic of Korea/epidemiology ; Retrospective Studies ; Seasons ; Severity of Illness Index ; Smoking ; Tomography, X-Ray Computed ; Young Adult

BACKGROUND/AIMS: Pleuropulmonary paragonimiasis produces no specific symptoms or radiologic findings, allowing for the possibility of misdiagnosis. We evaluated the specific clinical and pleural fluid features of pleuropulmonary paragonimiasis masquerading as pleural tuberculosis. METHODS: We retrospectively analyzed the clinical and radiologic characteristics of 20 patients diagnosed with pleuropulmonary paragonimiasis between 2001 and 2011. RESULTS: In total, 17 patients presented with respiratory symptoms, including dyspnea (30%), hemoptysis (20%), cough (20%), and pleuritic chest pain (15%). Chest radiographs revealed intrapulmonary parenchymal lesions, including air-space consolidation (30%), nodular opacities (20%), cystic lesions (15%), ground-glass opacities (10%), and pneumothorax (5%). A pleural f luid examination revealed eosinophilia, low glucose levels, and high lactate dehydrogenase (LDH) levels in 87%, 76%, and 88% of the patients, respectively. These traits helped to distinguish pleuropulmonary paragonimiasis from other pleural diseases such as parapneumonic effusion, malignancy, and pleural tuberculosis. CONCLUSIONS: Pleuropulmonary paragonimiasis is often initially misdiagnosed as other pleural diseases. Therefore, it is important to establish the correct diagnosis. In patients with unexplained pleural effusion living in paragonimiasis-endemic areas, pleural fluid obtained by thoracentesis should be examined to distinguish pleuropulmonary paragonimiasis. When marked eosinophilia, high LDH levels, and low glucose levels are identified in pleural fluid, physicians could consider a diagnosis of pleuropulmonary paragonimiasis.
Adolescent ; Adult ; Aged ; Animals ; Biological Markers/analysis ; Child ; Child, Preschool ; Diagnosis, Differential ; Enzyme-Linked Immunosorbent Assay ; Eosinophilia/diagnosis/parasitology ; Female ; Glucose/analysis ; Humans ; L-Lactate Dehydrogenase/analysis ; Lung Diseases, Parasitic/*diagnosis/metabolism/parasitology/radiography ; Male ; Middle Aged ; Paracentesis ; Paragonimiasis/*diagnosis/metabolism/parasitology/radiography ; Paragonimus westermani/*isolation & purification ; Pleural Effusion/*diagnosis/metabolism/parasitology/radiography ; Predictive Value of Tests ; Retrospective Studies ; Tomography, X-Ray Computed ; Tuberculosis, Pleural/*diagnosis ; Young Adult

Although idiopathic hypereosinophilic syndrome(IHES) commonly involves the lung, it is rarely associated with acute respiratory distress syndrome (ARDS). Here we describe a case of IHES presented in conjunction with ARDS. A 37-year-old male visited the emergency department at Samsung Medical Center, Seoul, Korea, with a chief complaint of dyspnea. Blood tests showed profound peripheral eosinophilia and thrombocytopenia. Patchy areas of consolidation with ground-glass opacity were noticed in both lower lung zones on chest radiography. Rapid progression of dyspnea and hypoxia despite supplement of oxygen necessitated the use of mechanical ventilation. Eosinophilic airway inflammation was subsequently confirmed by bronchoalveolar lavage, leading to a diagnosis of IHES. High-dose corticosteroids were administered, resulting in a dramatic clinical response.
Adrenal Cortex Hormones ; Adult ; Anoxia ; Bronchoalveolar Lavage ; Diagnosis ; Dyspnea ; Emergency Service, Hospital ; Eosinophilia ; Eosinophils ; Hematologic Tests ; Humans ; Hypereosinophilic Syndrome* ; Inflammation ; Korea ; Lung ; Male ; Oxygen ; Pulmonary Embolism ; Radiography ; Respiration, Artificial ; Respiratory Distress Syndrome, Adult* ; Seoul ; Thorax ; Thrombocytopenia

Eosinophilic otitis media (EOM) is a relatively rare, intractable, middle ear disease with extremely viscous mucoid effusion containing eosinophils. EOM is associated with adult bronchial asthma and nasal allergies. Conventional treatments for otitis media with effusion (OME) or for chronic otitis media (COM), like tympanoplasty or mastoidectomy, when performed for the treatment of EOM, can induce severe complications such as deafness. Therefore, it should be differentiated from the usual type of OME or COM. To our knowledge, the clinical and imaging findings of EOM of temporal bone are not well-known to radiologists. We report here the CT and MRI findings of two EOM cases and review the clinical and histopathologic findings of this recently described disease entity.
Adult ; Diagnosis, Differential ; Eosinophilia/*diagnosis/radiography/surgery ; Female ; Humans ; *Magnetic Resonance Imaging ; Otitis Media/*diagnosis/radiography/surgery ; Otoscopy ; Reoperation ; *Tomography, X-Ray Computed

Anti-IgE therapy, using recombinant humanized anti-IgE antibodies, is clinically effective in patients with eosinophil-related disorders such as allergic asthma, allergic rhinitis, and chronic urticaria. Chronic eosinophilic pneumonia tends to respond promptly to systemic corticosteroid therapy, however; relapses are common following corticosteroid tapering. We treated two patients (17- and 19-yr-old males) of chronic eosinophilic pneumonia whose symptoms were cough and dyspnea on exertion. The symptoms were recurrent while tapering off corticosteroid. They were treated with anti-IgE antibody without recurrence for 2 yr and 15 months. Here, we first describe clinical experience of the 2 cases of chronic eosinophilic pneumonia.
Adolescent ; Adrenal Cortex Hormones/therapeutic use ; Antibodies, Anti-Idiotypic/*therapeutic use ; Cough/etiology ; Dyspnea/etiology ; Humans ; Male ; Pulmonary Eosinophilia/diagnosis/radiography/*therapy ; Tomography, X-Ray Computed ; Young Adult

Eosinophilic enteritis is an uncommon disease that rarely manifests as an acute abdomen. A 50-year-old man visited our hospital and complained of epigastric and periumbilical pain. He reported direct and rebound tenderness over the periumbilical area. Laboratory examinations showed leukocytosis without eosinophilia. Plain abdominal radiography revealed air-fluid levels in the small intestine and computed tomography revealed concentric wall thickening in the small bowel and ascites in the pelvic cavity. We conducted an emergency operation and segmental resection of the jejunum was performed. Histologically, transmural, eosinophilic infiltration was observed. In patients with intestinal obstruction, even when presenting with an acute abdomen with no peripheral eosinophilia, eosinophilic enteritis should be included in the differential diagnosis.
Abdomen, Acute ; Ascites ; Diagnosis, Differential ; Emergencies ; Enteritis ; Eosinophilia ; Eosinophils ; Gastritis ; Gastroenteritis ; Humans ; Intestinal Obstruction ; Intestine, Small ; Jejunum ; Leukocytosis ; Middle Aged ; Radiography, Abdominal

An 82-yr-old man was presented with fever and cough accompanied by generalized erythematous rash. He had taken mexiletine for 5 months, as he had been diagnosed with dilated cardiomyopathy and ventricular arrhythmia. Laboratory studies showed peripheral blood eosinophilia and elevated liver transaminase levels. Chest radiographs showed multiple nodular consolidations in both lungs. Biopsies of the lung and skin lesions revealed eosinophilic infiltration. After a thorough review of his medication history, mexiletine was suspected as the etiologic agent. After discontinuing the mexiletine and starting oral prednisolone, the patient improved, and the skin and lung lesions disappeared. Subsequently, mexiletine was confirmed as the causative agent based on a positive patch test. Drug-induced hypersensitivity syndrome is a severe adverse reaction to drugs and results from treatment with anticonvulsants, allopurinol, sulfonamides, and many other drugs. Several cases of mexiletine-induced hypersensitivity syndrome have been reported in older Japanese males with manifestation of fever, rash, peripheral blood eosinophilia, liver dysfunction without other organ involvement. Here, we report a case of mexiletine-induced hypersensitivity syndrome which presented as eosinophilic pneumonia in a Korean male.
Aged, 80 and over ; Anti-Arrhythmia Agents/*adverse effects ; Arrhythmias, Cardiac/drug therapy ; Cardiomyopathy, Dilated/drug therapy ; Drug Hypersensitivity/*diagnosis/etiology ; Exanthema/pathology ; Humans ; Lung/pathology/radiography ; Male ; Mexiletine/*adverse effects ; Pulmonary Eosinophilia/*chemically induced/*diagnosis ; Syndrome ; Tomography, X-Ray Computed

BACKGROUND/AIMS: Eosinophilic gastroenteritis (EG) is a rare disease characterized by prominent eosinophilic infiltration that may involve a variable depth of one or more gastrointestinal organs. We analyzed the largest number of patients with EG among the studies carried out at a single center in Korea. METHODS: We retrospectively analyzed the clinical, laboratory, endoscopic, and radiologic features, management, and clinical outcome in 17 patients who were diagnosed as EG from January 1994 to Febuary 2008. RESULTS: Median age was 36 (2-67 years). Two of the 17 patients had a history of allergy. The most common symptoms were abdominal pain and diarrhea. Fifteen patients (88.2%) had hypereosinophilia. The ESR was moderately raised in 6 out of 14 patients. Eleven patients (64.7%) had predominant involvement of the mucosa, 1 (5.9%) of muscularis, and 5 (29.4%) of subserosa. EGD revealed non-specific findings such as erythema and edema. Abdominal Computed tomography revealed gastrointestinal wall thickenings of the involved organ, and all of 5 cases of the subserosal type had ascites. Thirteen patients (76.5%) were improved by corticosteroid treatment. Among five patients who had been followed for more than one year (12-84 months), two experienced relapse after discontinuing corticosteroids. CONCLUSIONS: EG should be considered in the differential diagnosis of unexplained gastrointestinal symptoms even in the absence of peripheral eosinophilia and in non-specific endoscopic findings.
Adolescent ; Adrenal Cortex Hormones/therapeutic use ; Adult ; Aged ; Azathioprine/therapeutic use ; Child ; Child, Preschool ; Diagnosis, Differential ; Endoscopy, Digestive System ; Eosinophilia/complications/*diagnosis/radiography ; Female ; Gastroenteritis/*diagnosis/drug therapy/radiography ; Humans ; Immunosuppressive Agents/therapeutic use ; Male ; Middle Aged ; Recurrence ; Retrospective Studies ; Tomography, X-Ray Computed