Eosinophilic Pneumonias

Eosinophilic Pneumonias is a topic covered in the 5-Minute Clinical Consult.

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Basics

Description

  • Eosinophilic pneumonias (pulmonary eosinophilia) are a heterogenous group of diseases with a similar clinical syndrome and overlapping findings on imaging.
  • Primary and secondary causes (1,2):
    • Primary:
      • Acute idiopathic eosinophilic pneumonia (AEP)
      • Chronic idiopathic eosinophilic pneumonia (CEP)
      • Eosinophilic granulomatosis with polyangiitis (EGPA) previously called Churg-Strauss syndrome (CSS) (3)
      • Hypereosinophilic syndromes
    • Secondary causes: allergic bronchopulmonary aspergillosis (ABPA), Löffler syndrome, parasitic infections, drug- or toxin-induced
    • Löffler syndrome also overlaps PIE syndrome.

Epidemiology

Incidence
  • Uncommon in United States, rates not specifically reported
  • CEP ~1–2% of all interstitial lung disease (ILD)

Prevalence
  • Predominant age: varies depending on exact process
  • Predominant sex:
    • AEP: male = female usually young patients
    • CEP: female > male (2:1), no difference after age 60 years
    • ABPA: 7–14% of all asthmatics, rare in nonasthmatics (4)

Etiology and Pathophysiology

  • No single etiology for the diverse cluster of diseases
  • Idiopathic (AEP, CEP)
  • Hypersensitivity (ABPA, Löffler syndrome)
  • Cigarette smoking (AEP)
  • Heavy dust and other occupational exposures (AEP)
  • Infectious: parasites, filariae, nematodes (Löffler syndrome), specifically Ascaris most common worldwide. Others include Strongyloides hookworms, filarial nematodes, Toxocara, and Paragonimus.
  • Drug-induced: 120 known associations; most common: NSAIDs, minocycline, nitrofurantoin, cocaine

Genetics
No known genetic pattern

Risk Factors

  • Often idiopathic, hard to tell what is true risk factor versus association and cause
  • AEP
    • Drugs
    • Inhalation of toxic products
    • Cigarette smoking
  • CEP
    • Drugs
    • Irradiation for breast cancer
    • Asthma
  • ABPA (4)
    • Asthma (usual duration 8 to 12 years prior)

Commonly Associated Conditions

  • Asthma (ABPA, CSS)
  • Cystic fibrosis (ABPA)
  • Atopy (notable for CEP)
  • Tobacco use (AEP)

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Citation

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TY - ELEC T1 - Eosinophilic Pneumonias ID - 816332 ED - Baldor,Robert A, ED - Domino,Frank J, ED - Golding,Jeremy, ED - Stephens,Mark B, BT - 5-Minute Clinical Consult, Updating UR - https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816332/all/Eosinophilic_Pneumonias PB - Wolters Kluwer ET - 27 DB - Medicine Central DP - Unbound Medicine ER -