Associates' Presentations
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Eosinophilic pneumonia: Idiopathic vs. drug induced.
K.E. Walsh, D.O. (Associate). University of Wisconsin Hospital - Department of Internal Medicine, Madison, WI.
An increase in circulating or tissue eosinophils in the common finding in a diverse group of pulmonary disorders known as eosinophilic lung diseases. The eosinophilic cell can release a large number of cytokines, oxygen radicals, arachidonic acid metabolites, lipid mediators in addition to the cell's own distinctive granules. All of these mediators combined can lead to substantial lung tissue injury. Presently eosinophilic lung diseases can be identified and categorized by one of these means. First, through peripheral blood eosinophilia and chest x-ray infiltrates. Second, via a more direct means with a lung biopsy. Finally, by way of the minimally invasive bronchoalveolar lavage procedure, which can be performed at multiple time points in the course of the disease. Reported is an unusual case of eosinophilic pneumonia in the setting of potential alternative/homeopathic medicine contribution.
A 57 year old Caucasian woman with nonproductive dry cough, shaking chills and fever x 1 week. At presentation the patient had bilateral apical infiltrates on x-ray, WBC 17.7, 50% (relative) eosinophils, 8,800 (absolute) eosinophils, GGT 50 AST 29, ALT 86, LDH 245, ESR 61. PPD-neg., ANA-neg., Complement Levels C3, C4 and CH50 all wnl., Blasto & Coccida CF AB <1:8, Histo serology <1:8, Fungal serology-neg. High resolution chest CT revealed bilateral apical and left superior lobe infiltrates. Bronchoscopy with no gross abnormalities. BAL with biopsy demonstrated eosinophilic infiltration throughout lung fields with negative results for legionella and AFB. Patient was discharged with an oral prednisone taper regiment and was instructed to discontinue all homeopathic medications, most notably dried liver fluke and dog heartworm pills. Patient returned to clinic after one month, symptom free, with laboratory and chest x-ray results withing normal limits.
Discussion - With the heightened interest in homeopathic medicine, the potential for drug reactions/interactions increases dramatically. As new "agents" are brought to market and exposure to toxic agents occurs, the list of eosinophilic lung diseases will continue to grow. Corticosteroids remain the mainstay of treatment for many of the eosinophilic lung diseases. Corticosteroids work by blocking production of eosinophils by bone marrow, inhibiting adherence of eosinophils and by overcoming the effect of the cytokines responsible for prolonging eosinophilic survival.
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