A case of sarcoidosis associated with chronic eosinophilic pneumonia

Halil Yanardag, Cuneyt Tetikkurt, Aslı Sezgin, Ertuğrul Oruc, Muammer Bilir

Department of Internal Medicine, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey.
Department of Pathology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey.
Department of Pulmonary Diseases, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey.

DOI: 10.4236/crcm.2014.32022                

Abstract

A 78-year-old woman was referred to our university hospital due to dry cough, fever, and weight loss. Laboratory revealed blood eosinophilia, high ESR, CRP and LDH. Rheumatologic markers were negative. Chest X-ray showed ground glass opacities in upper lobes. Uveitis developed in the left eye 1 week after admission. Thorax CT revealed ground glass opacities, reticular appearence in the upper lobes, enlarged axillary and mediastinal lymph nodes. Bronchoalveolar lavage CD₄/CD₈ was 2.1 and had 48% eosinophils. Histopathologic examination revealed eosinophilic infiltration and non-caseating epitheloid granulomas in the lung and mediastinal lymph nodes without vasculitis. Symptoms, blood eosinophilia and initial thorax CT findings improved after two months of methylprednisolone treatment. Chronic eosinophilic pneumonia is a rare disease characterized by systemic and pulmonary manifestations. It may be associated with other diseases.

Keywords

Sarcoidosis; Chronic Eosinophilic Pneumonia; Pulmonary Eosinophilia

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Fox, B. and Seed, W. (1980) Chronic eosinophilic pneumonia. Thorax, 35, 570-580. http://dx.doi.org/10.1136/thx.35.8.570
[2]	Wubbel, C., Fulmer, D. and Sherman, J. (2003) Chronic eosinophilic pneumonia: A case report and national survey. Chest, 123, 1763-1766. http://dx.doi.org/10.1378/chest.123.5.1763
[3]	Naughton, M., Fahy, J. and Fitzgerald, M.X. (1993) Chronic eosinophilic pneumonia. A long term follow-up of 12 patients. Chest, 103, 162-165. http://dx.doi.org/10.1378/chest.103.1.162
[4]	Hayakawa, H., Sato, A., Toyoshima, M., et al. (1994) A clinical study of idiopathic eosinophilic pneumonia. Chest, 105, 1462-1465. http://dx.doi.org/10.1378/chest.105.5.1462
[5]	Carrington, C.B., Addington, W.W., Goff, A.M., et al. (1969) Chronic eosinophilic pneumonia. New England Journal of Medicine, 280, 787-798. http://dx.doi.org/10.1056/NEJM196904102801501
[6]	Hayakawa, H., Sato, A., Toyoshima, M., Imokawa, S. and Taniguchi, M. (1994) A clinical study of idiopathic eosinophilic pneumonia. Chest, 105, 1462-1466. http://dx.doi.org/10.1378/chest.105.5.1462
[7]	Grantham, J.G., Meadows III, J.A. and Gleich, G.J. (1986) Chronic eosinophilic penumonia: Evidence for eosinophilic degranulation and release of major basic protein. American Journal of Medicine, 80, 89-94. http://dx.doi.org/10.1016/0002-9343(86)90053-7
[8]	Gaensler, E.A. and Carrington, C.B. (1977) Peripheral opacities in chronic eosinophilic pneumonia: The photographic negative of pulmonary edema. AJR, 128, 1-13. http://dx.doi.org/10.2214/ajr.128.1.1
[9]	Tani, K., Kasho, M., Sano, N., Nalamura, Y., Ogushi, F. and Sone, S. (1998) A case of sarcoidosis associated with chronic eosinophilic pneumonia. Journal of Investigative Medicine, 45, 131-136.
[10]	Shijubo, N., Fujishima, T., Morita, S., Nakata, H., Satoh, M., Uno, E., Morikawa, T. and Abe, S. (1995) Idiiopathic chronic eosinophilic pneumonia associated with non-caseating granulomas. European Respiratory Journal, 8, 327-330. http://dx.doi.org/10.1183/09031936.95.08020327
[11]	Allen, J.N., Davis, W.B. and Pacht, E.R. (1990) Diagnostic significance of increased bronchoalveolar lavage fluid eosinophils. American Review of Respiratory Disease, 142, 642-647. http://dx.doi.org/10.1164/ajrccm/142.3.642
[12]	Allen, J.N. and Davis, W.B. (1994) Eosinophilic lung diseases. American Journal of Respiratory and Critical Care Medicine, 150, 1423-1438. http://dx.doi.org/10.1164/ajrccm.150.5.7952571
[13]	Renston, J., Goldman, E., Hsu, R., et al. (2000) Peripheral blood eosinophilia in association with sarcoidosis. Mayo Clinic Proceedings, 75, 586-590. http://dx.doi.org/10.4065/75.6.586
[14]	Jederlinic, P.J., Sicilian, L. and Gaensler, E.A. (1988) Chronic eosinophilic pneumonia. A report of 19 cases and a review of the literature. Medicine (Baltimore), 67, 154-162. http://dx.doi.org/10.1097/00005792-198805000-00002