Diagnostic pitfalls of acute eosinophilic pneumonia in an ad
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A previously healthy 15-year-old boy presented to the Emergency Department for the chief complaint of shortness of breath for one day. He reported a sudden onset of mild chest pain, accompanied by mild cough. The patient had no fever or other systemic symptoms and also denied any personal and family history of any allergic conditions.

On arrival at the emergency department, the patient's initial vital signs revealed tachycardia and tachypnea. Arterial blood gas determination on room air showed pH of 7.451, PaCO2 of 34.4 mm Hg, PaO2 of 55.1 mm Hg, HCO3− of 23.4 mmol/L and saturation of 90.6%. Physical examination revealed bilateral coarse crackles breathing sounds without wheezing. Laboratory data revealed leukocytosis of 20.8 × 103 cells/μL, with 83% segments, 9% lymphocytes, and 8% monocytes. Chest radiograph showed increased perihilar infiltration, without signs of cardiomegaly and pleural effusion.

After admission, patient developed fever and worsening hypoxemia. Follow-up chest radiograph on the first hospital day revealed bilateral perihilar infiltration with right lower lobe consolidation. Due to suspected bacterial pneumonia, the patient received antibiotic therapy. However, patient's symptoms persisted despite two days of antibiotic treatment. Laboratory tests were re-checked, which showed normal white blood cells count of 6.4 × 103 cells/μL with eosinophilia of 9.8%, and highly elevated C-reactive protein (223.2 mg/L) levels.

The increase in eosinophilic count prompted re-evaluation of the history-taking process, which revealed that the patient's symptoms arose after he took one deep breath of cigarette smoke. Under the impression of AEP, bronchoalveolar lavage (BAL) was performed on the third hospital day and showed a white blood cell count of 372/μL, with 88% eosinophils, 7% neutrophils, and 5% lymphocytes. With the confirmation of the diagnosis of AEP, the patient was treated with corticosteroids. His condition improved with resolution of infiltration at the right lower lobe within 24 hours.

Source: Medicine: May 2019 - Volume 98 - Issue 20 - p e15590

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