CHRONIC EOSINOPHILIC PNEUMONIA WITH ATYPICAL RADIOLOGICAL PRESENTATION IN AN ELDERLY PATIENT: CASE REPORT

Yıl 2014, Cilt: 28 Sayı: 1, 45 - 50, 01.05.2014

Sarıoğlu Nurhan Erel Fuat Demirpolat Gülen

Öz

Chronic eosinophilic pneumonia (CEP) is a rare interstitial lung disease characterized by subacute dyspnea, peripheral infiltrates on the chest radiography and pulmonary eosinophilia. It is frequently confused with bacterial pneumonia or other causes of pulmonary consolidation. A 74- year-old woman patient who had cough and fatigue lasting during last two months was referred to our clinic, because she was not recovered by nonspesific antibiotherapy. Unilateral peripheral consolidation were seen on the chest tomography of the patient who had not fever and leukocytosis. Bronchoscopy, bronchoalveolar lavage (BAL) was performed. Clinical, radiological and pathological findings of the patient diagnosed as CEP were significantly recovered by corticosteroid treatment. The case was presented because of her advanced age and atipic radiological findings and the literature is reviewed.

Anahtar Kelimeler

Eosinophilic Pneumonia, eosinophilia

İLERİ YAŞTA ATİPİK RADYOLOJİK GÖRÜNÜMLÜ KRONİK EOZİNOFİLİK PNÖMONİ: OLGU SUNUMU

Öz

Kronik Eozinofilik Pnömoni (KEP), subakut dispne, akciğer grafisinde periferal infiltratlar ve pulmoner eozinofili ile karakterize nadir bir interstisyel akciğer hastalığıdır. Sıklıkla bakteriyel pnömoni ve diğer pulmoner konsolidasyon nedenleri ile karışabilir. İki aydır öksürük ve dispne öyküsü olan 74 yaşında kadın olgu, nonspesifik antibiyotik tedavisine yanıt alınamaması üzerine kliniğimize refere edildi. Ateş ve lökositozu olmayan olgunun bilgisayarlı tomografisinde sağ akciğerde belirgin olmak üzere periferal yamalı konsolidasyonlar izlenmekteydi. Olguya bronkoskopi, bronkoalveoler lavaj (BAL) yapıldı. Klinik, radyolojik ve patoloji bulguları ile KEP tanısı konuldu. Steroid tedavisi ile klinik, radyolojik bulgularda dramatik iyileşme gözlendi. İleri yaşta olması ve atipik radyolojik bulgular göstermesi nedeniyle literatür eşliğinde sunuldu.

Anahtar Kelimeler

Eozinofilik pnömoni, eozinofili

Kaynakça

• 1. Alam M, Burki NK. Chronic Eosinophilic Pneumonia: A Review. Southern Medical Journal 2007; 100 (1): 49-53.
• 2. Saita N, Yamanaka T, Kohrogi H, Ando M, Hirashima M. Apoptotic response of eosinophils in chronic eosinophilic pneumonia. Eur Respir J 2001; 17: 190–4.
• 3. Samitas K, Rådinger M, Bossios A. Current update on eosinophilic lung diseases and antiIL-5 treatment. Recent Pat Antiinfect Drug Discov 2011; 6(3): 189-205.
• 4. Bhatt NY, Allen JN. Update on eosinophilic lung diseases. Semin Respir Crit Care Med 2012 Oct; 33(5): 555-71.
• 5. Carrington CB, Addington WW, Goff AM, Madoff IM, Marks A, Schwaber JR, Gaensler EA. Chronic eosinophilic pneumonia. N Engl J Med 1969; 280 (15): 787–98.
• 6. Rochester CL, Crothers K. The Eosinophilic Pneumonıas. In: Fishman AP (ed). Pulmonary Diseases and Disorders. International ed.New York: Mc Graw Hill, 2008; 1220-2.
• 7. Tzilas V, Bastas A, Koti A, Papandrinopoulou D, Tsoukalas G. A 77 year old male with peripheral eosinophilia, pulmonary infiltrates and a small pleural effusion. Eur Rev Med Pharmacol Sci 2009; 13(3): 227-32.
• 8. 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): 972-5.
• 9. Kumasawa F, Kobayashi T, Noda A, Shintani Y, Koyama D, Oki T, Mizumura K, Nishinarita S, Sawada T, Hashimoto S. Chronic eosinophilic pneumonia presenting with acute onset. Asian Pac J Allergy Immunol 2012; 30(4): 321-5.
• 10. Allen JN. Drug-induced eosinophilic lung disease. Clin Chest Med. 2004; 25(1): 77-88.
• 11. Al-Tawfiq JA, Doujaiji B. Bilateral upper-lobe peripheral consolidation in a 56-year-old woman. Chest 2008; 133(6): 1512-6.
• 12. Hernández JJ, Fuentes AM, Mercado CM, Pereira PA. Chronic Eosinophilic Pneumonia: Autoimmune Phenomenon or Immunoallergic Disease? Case Report and Literature Review. Reumatol Clin 2012; 8(3): 145–148.
• 13. Jeong YJ, Kim KI, Seo IJ, Lee CH, Lee KN, Kim KN, Kim JS, Kwon WJ. Eosinophilic lung diseases: a clinical, radiologic, and pathologic overview. Radiographics 2007; 27(3): 617-37.
• 14. Şahbaz S, Uçan ES, Sevinç C, Ceylan E, Alacacıoğlu A, Kargı A. Atipik klinik ve radyolojik seyirli bir kronik eozinofilik pnömoni olgusu. Tüberküloz ve Toraks Dergisi 2004; 52(2): 171-174.
• 15. Cottin V, Frognier R, Monnot H, Levy A, DeVuyst P, Cordier. Chronic eosinophilic pneumonia after radiation therapy for breast cancer. Eur Respir J 2004; 23(1): 9-13.
• 16. Shin YS, Jin HJ, Yoo HS, Hwang EK, Nam YH, Ye YM, Park HS. Successful treatment of chronic eosinophilic pneumonia with anti-IgE therapy. J Korean Med Sci 2012; 27(10): 1261-4.
• 17. Kaya H, Gümüş S, Uçar E, Aydoğan M, Muşabak U, Tozkoparan E, Bilgiç H. Omalizumab as a steroid-sparing agent in chronic eosinophilic pneumonia. Chest 2012; 142(2): 513-6.