The Other P.I.E.Pulmonary Infiltrates WithEosinophiliaEosinophilic Lung Disease

The Other P.I.E.Pulmonary Infiltrates WithEosinophiliaEosinophilic Lung Disease

©  William Herring, MD, FACR

Pulmonary Infiltrates withEosinophilia

Pulmonary disease affecting  majorairways and/or lung parenchymaassociated with blood and/or tissueeosinophilia

Eosinophilic Lung DiseaseClassification by Clinical Severity

BenignLoeffler’s syndrome

IntermediateEosinophilic pneumonia

SevereHypersensitivity AngiitisPolyarteritis nodosa

Idiopathic

Associated With Specific Etiology

Associated with Connective TissueDisease or Vasculitis

Eosinophilic Lung DiseaseClassification by Etiology

Loeffler’s syndrome

Acute Eosinophilic Pneumonia

Chronic Eosinophilic Pneumonia

Hypereosinophilic syndrome

Eosinophilic Lung DiseaseIdiopathic

Atopic history common

May be asymptomatic or very symptomatic

High fever and dyspnea

Associated with blood eosinophilia

Biopsies also show eosinophils in infiltrate

Loeffler’s SyndromeGeneral Considerations

May present as reverse pulmonary edema

Infiltrates may be single or multiple

Usually transitory airspace opacities

Reduction in size of one infiltrate in 24hrs with appearance of a 2nd issuggestive

Infiltrates are usually peripheral

Loeffler’s SyndromeImaging Findings

Loeffler’s syndrome

Chronic Eosinophilic PneumoniaGeneral

Very rare disease (188 cases)

More protracted course than Loeffler’s

Atopic history

Female:male    2:1

Chronic Eosinophilic PneumoniaPathology

High levels of circulating IgE

Eosinophilic abscesses in lung

Blood eosinophilia

Pathologically identical to Loeffler’s

Chronic Eosinophilic PneumoniaX-ray

Similar to Loeffler’s except infiltrateslast for many days or week withoutsteroids

Chronic Eosinophilic PneumoniaClinical

Most are asymptomatic or mild symptoms

Some have

High fever

Malaise

Weight loss

Respond within days to steroid therapy

Idiopathic

Associated With Specific Etiology

Associated with Connective TissueDisease or Vasculitis

Eosinophilic Lung DiseaseClassification of PIE by Etiology

Eosinophilic Lung DiseaseSpecific Etiology

Drug-induced

Nitrofurantoin

Penicillin

Sulfonamides

Parasite-induced

Ascariasis

Paragonomiasis

Parasite-induced

Strongyloidiasis

TropicalEosinophilia

Fungus-induced

ABPA

Eosinophilic Lung DiseaseDrug-induced

Interstitial edema

Most commonly nitrofurantin

Patchy, fleeting air space disease

Amiodarone

Penicillin

Sulfonamides

Hydrochlorthiazide

Nitrofurantoin (Furadantin)

Diseasedisappearsshortly afterremoval ofantibiotic

Amiodarone

Eosinophilic Lung DiseaseParasite-induced

Most often from Ascaris lumbricoides

Caused by the larva as they passthrough lungs

Allergic response of patchy, fleetinginfiltrates

Blood eosinophilia

Idiopathic

Associated With Specific Etiology

Associated with Connective TissueDisease or Vasculitis

Eosinophilic Lung DiseaseClassification of PIE by Etiology

Rheumatoid Disease

Granulomatosis with Polyangiitis(Wegener’s Granulomatosis)

Allergic Granulomatosis

Polyarteritis Nodosa

Eosinophilic Lung DiseaseConnective Disease or Vasculitis

Multiple nodules ofvarying sizes withfrequent cavitation

Granulomatosis with Polyangiitis

The End