Chronic eosinophilic pneumonia
Patients typically present with several months of gradual onset of symptoms including fever, dyspnea, productive cough, weight loss, and night sweats. Physical examination may reveal wheezing or crackles in approximately 1/3 of patients. Prognosis is generally quite good despite relapses and the need for long-term therapy.
J82.81 – Chronic eosinophilic pneumonia
233692000 – Cryptogenic pulmonary eosinophilia
Differential Diagnosis & Pitfalls
- Acute eosinophilic pneumonia – Typically much more fulminant / acute course, more severe hypoxemia, absence of peripheral blood eosinophilia.
- Allergic bronchopulmonary aspergillosis (ABPA) – Different radiographic abnormalities: ABPA has central bronchiectasis, fleeting infiltrates, mucous plugging; also elevated IgE and sensitivity to aspergillus.
- Eosinophilic pneumonia due to drugs – Nonsteroidal anti-inflammatory drugs (NSAIDs) and antibiotics such as nitrofurantoin, minocycline, sulfa meds, ampicillin, and daptomycin are among the most common, but many other medications / drugs have been reported.
- Eosinophilic pneumonia due to toxins (silicate, sulfite, scorpion stings, heroin / crack cocaine / marijuana, dust or smoke inhalation).
- Eosinophilic granulomatosis with polyangiitis (Churg Strauss syndrome) – More likely to have extrapulmonary manifestations; radiographic abnormalities are generally mid-upper lung zone and centrilobular rather than peripheral.
- Fungal pneumonia (eg, cryptococcosis, aspergillosis, mucormycosis, coccidioidomycosis, histoplasmosis) – Also has eosinophilia on bronchoalveolar lavage (BAL); obtain travel history or history of immunosuppression.
- Parasitic infection (Ascaris, Strongyloides, Paragonimus, Toxocara) – Also has eosinophilia on BAL; obtain travel history or history of immunosuppression.
- Cryptogenic organizing pneumonia – BAL eosinophilia absent.
- Pneumonia / infection – BAL eosinophilia absent.
- Asthma – Usually would not have characteristic chest x-ray (CXR) findings or fever; BAL eosinophilia absent or low grade.
- Congestive heart failure – BAL eosinophilia absent; patient would likely not have fever and would have other signs / symptoms of heart failure.
- Diffuse alveolar hemorrhage – BAL eosinophilia absent; instead see blood return on BAL.
Drug Reaction Data