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Atsumi K, Nishima S, Tanaka T, Kamio K, Taniuchi N, Saito Y, Shimizu M, Okano T, Seike M, Hirose T. Optimal dose of maintenance steroid therapy for relapse of chronic eosinophilic pneumonia: a multicentre retrospective study. BMJ Open Respir Res 2025; 12:e002697. [PMID: 40379264 PMCID: PMC12086887 DOI: 10.1136/bmjresp-2024-002697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2024] [Accepted: 04/29/2025] [Indexed: 05/19/2025] Open
Abstract
BACKGROUND Long-term maintenance steroid therapy (MST) is often necessary for repeated relapses of chronic eosinophilic pneumonia (CEP). Because relapse does not indicate a worse prognosis, determining the optimal steroid dose to avoid overtreatment presents a clinical challenge. Our primary objective was to evaluate the optimal MST dose to prevent repeated relapses, and the secondary objectives included identifying serum eosinophil count at relapse and background factors of relapse. METHODS A multicentre retrospective study was conducted on patients with steroid-treated CEP. Background characteristics were compared between the non-relapse and relapse groups. The optimal MST dose was determined based on dose at relapse and the final relapse prevention dose. Additionally, serum eosinophil count at relapse was assessed. RESULTS A total of 79 patients were included, with 44 in the non-relapse group and 35 in the relapse group. The prednisolone doses required to achieve relapse-free rates of 50% (ED50) were 7.2 mg (95% CI, 4.6 to 23.6). The median serum eosinophil count at relapse was 1125 /µL (IQR, 735-2108). No clinically significant background factors were identified between the non-relapse and relapse groups. CONCLUSION Our study demonstrated that a prednisolone dose of 7.2 mg achieved a 50% relapse-free rate in the relapse group. Based on these findings, we encourage clinicians to evaluate individual minimum effective steroid doses.
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Affiliation(s)
- Kenichiro Atsumi
- Department of Pulmonary Medicine and Medical Oncology, Nippon Medical School Tama Nagayama Hospital, Tama-shi, Tokyo, Japan
| | - Shunichi Nishima
- Department of Pulmonary Medicine and Medical Oncology, Nippon Medical School Tama Nagayama Hospital, Tama-shi, Tokyo, Japan
| | - Toru Tanaka
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Bunkyo-ku, Tokyo, Japan
| | - Koichiro Kamio
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Bunkyo-ku, Tokyo, Japan
| | - Namiko Taniuchi
- Department of Respiratory Medicine, Nippon Medical School Musashi Kosugi Hospital, Kawasaki-shi, Kanagawa, Japan
| | - Yoshinobu Saito
- Department of Respiratory Medicine, Nippon Medical School Musashi Kosugi Hospital, Kawasaki-shi, Kanagawa, Japan
| | - Masamitsu Shimizu
- Department of Respiratory Medicine, Nippon Medical School Chiba Hokusoh Hospital, Inba-gun, Chiba, Japan
| | - Tetsuya Okano
- Department of Respiratory Medicine, Nippon Medical School Chiba Hokusoh Hospital, Inba-gun, Chiba, Japan
| | - Masahiro Seike
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Bunkyo-ku, Tokyo, Japan
| | - Takashi Hirose
- Department of Pulmonary Medicine and Medical Oncology, Nippon Medical School Tama Nagayama Hospital, Tama-shi, Tokyo, Japan
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Sellers T, Alman K, Machurick M, Faust H, Kanne J. Acute Pulmonary Injury: An Imaging and Clinical Review. J Thorac Imaging 2025; 40:e0825. [PMID: 40094310 DOI: 10.1097/rti.0000000000000825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2025]
Abstract
Acute pulmonary injury can occur in response to any number of inciting factors. The body's response to these insults is much less diverse and usually categorizable as one of several patterns of disease defined by histopathology, with corresponding patterns on chest CT. Common patterns of acute injury include diffuse alveolar damage, organizing pneumonia, acute eosinophilic pneumonia, and hypersensitivity pneumonitis. The ultimate clinical diagnosis is multidisciplinary, requiring a detailed history and relevant laboratory investigations from referring clinicians, identification of injury patterns on imaging by radiologists, and sometimes tissue evaluation by pathologists. In this review, several clinical diagnoses will be explored, grouped by imaging pattern, with a representative clinical presentation, a review of the current literature, and a discussion of typical imaging findings. Additional information on terminology and disambiguation will be provided to assist with comprehension and standardization of descriptions. The focus will be on the acute phase of illness from presentation to diagnosis; treatment methods and chronic sequela of acute disease are beyond the scope of this review.
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Affiliation(s)
| | - Kirsten Alman
- Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Maxwell Machurick
- Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Hilary Faust
- Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI
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Al Achkar M, Zaidan N, Lahoud C, Zubair Z, Schwartz J, Abidor E, Kaspar C, El Hage H. Intubation in Eosinophilic Lung Disease: Predictors, Outcomes, and Characteristics from a National Inpatient Sample Analysis. MEDICINA (KAUNAS, LITHUANIA) 2025; 61:556. [PMID: 40282847 PMCID: PMC12028457 DOI: 10.3390/medicina61040556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2025] [Revised: 03/12/2025] [Accepted: 03/19/2025] [Indexed: 04/29/2025]
Abstract
Background and Objectives: Eosinophilic lung diseases (ELD) encompass disorders with an abnormally high number of polymorphonuclear eosinophils in the lungs. Presentation severity can range from low-grade fever and cough to life-threatening acute respiratory distress syndrome (ARDS). Due to the rarity of these conditions, no large sample studies have been performed to assess the characteristics of patients with pulmonary eosinophilia. Materials and Methods: Patients admitted with a diagnosis of pulmonary eosinophilia between the years 2016 and 2020 were extracted from the largest inpatient US database, the Nationwide Inpatient Sample (NIS). Patients under the age of eighteen and those with diabetic ketoacidosis were excluded. Baseline demographic characteristics and medical comorbidities were evaluated for individuals admitted with pulmonary eosinophilia depending on intubation requirement. The primary outcomes included in-hospital mortality, intubation, and length of stay (LOS). Results: 3784 records were extracted, among which 384 patients required intubation. Patients who required intubation had higher rates of in-hospital mortality (23.9% vs. 1.2% p < 0.0001%) and a significantly more prolonged hospital stay (19 days vs. 6 days p < 0.001) compared to patients who did not need intubation. Factors associated with mortality in the intubated group included increasing age (OR: 1.022, 95% CI 1.002-1.042), duration of intubation superior to 96 h (OR: 2.705, 95% CI 1.235-5.927), and AKI (OR: 2.964, 95% CI 1.637-5.366). Conclusions: Our findings suggest that ELD patients requiring intubation experience significantly higher rates of in-hospital mortality, acute kidney injury, deep venous thrombosis, and ARDS.
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Affiliation(s)
- Michel Al Achkar
- Department of Medicine, Northwell Health, Staten Island University Hospital, New York, NY 10305, USA; (N.Z.); (C.L.); (Z.Z.); (J.S.); (E.A.); (C.K.)
| | - Nadim Zaidan
- Department of Medicine, Northwell Health, Staten Island University Hospital, New York, NY 10305, USA; (N.Z.); (C.L.); (Z.Z.); (J.S.); (E.A.); (C.K.)
| | - Chloe Lahoud
- Department of Medicine, Northwell Health, Staten Island University Hospital, New York, NY 10305, USA; (N.Z.); (C.L.); (Z.Z.); (J.S.); (E.A.); (C.K.)
| | - Zaineb Zubair
- Department of Medicine, Northwell Health, Staten Island University Hospital, New York, NY 10305, USA; (N.Z.); (C.L.); (Z.Z.); (J.S.); (E.A.); (C.K.)
| | - Jessica Schwartz
- Department of Medicine, Northwell Health, Staten Island University Hospital, New York, NY 10305, USA; (N.Z.); (C.L.); (Z.Z.); (J.S.); (E.A.); (C.K.)
| | - Erica Abidor
- Department of Medicine, Northwell Health, Staten Island University Hospital, New York, NY 10305, USA; (N.Z.); (C.L.); (Z.Z.); (J.S.); (E.A.); (C.K.)
| | - Chris Kaspar
- Department of Medicine, Northwell Health, Staten Island University Hospital, New York, NY 10305, USA; (N.Z.); (C.L.); (Z.Z.); (J.S.); (E.A.); (C.K.)
| | - Halim El Hage
- Department of Pulmonary Medicine, Northwell Health, Staten Island University Hospital, New York, NY 10305, USA;
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Zeckanovic A, Scheidegger N, Prader S, Thanikkel L, Elgizouli M, Bodmer N. Pediatric Acute B-Lymphoblastic Leukemia Presenting as Hypereosinophilia With Lung Involvement and Elevated Immunoglobulin E Levels. Pediatr Blood Cancer 2025; 72:e31461. [PMID: 39558856 DOI: 10.1002/pbc.31461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2024] [Revised: 11/03/2024] [Accepted: 11/08/2024] [Indexed: 11/20/2024]
Affiliation(s)
- Aida Zeckanovic
- Department of Oncology, University Children's Hospital Zurich, Zurich, Switzerland
| | | | - Seraina Prader
- Department of Immunology, University Children's Hospital Zurich, Zurich, Switzerland
| | - Leo Thanikkel
- Department of Pulmonology, University Children's Hospital Zurich, Zurich, Switzerland
| | | | - Nicole Bodmer
- Department of Oncology, University Children's Hospital Zurich, Zurich, Switzerland
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Zima K, Bogucka A, Wojtas M, Zabielska-Kaczorowska M. Immunological Effects of Electronic Cigarette Use: A Review of Current Evidence. Clin Rev Allergy Immunol 2025; 68:9. [PMID: 39891861 DOI: 10.1007/s12016-025-09026-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2025] [Indexed: 02/03/2025]
Abstract
Electronic cigarettes (EC) have emerged as a popular alternative to traditional tobacco products, but their impact on immune function has raised significant health concerns. This review explores the immunological effects of EC exposure, focusing on innate and adaptive immune responses. Electronic cigarette aerosol (ECA) induces widespread inflammation. These changes compromise immune cell function, impairing neutrophil chemotaxis, phagocytosis, and oxidative burst while increasing macrophage and dendritic cell recruitment and activation. ECA also disrupts epithelial barriers, increasing susceptibility to bacterial and viral infections. Studies show enhanced biofilm formation in bacteria such as Staphylococcus aureus and Streptococcus pneumoniae and impaired antiviral responses against pathogens like influenza A and SARS-CoV-2. Additionally, EC exposure modulates adaptive immunity, affecting T and B cell function and increasing systemic inflammatory markers. The long-term consequences of these immunological disruptions include heightened risks for chronic inflammatory diseases, respiratory infections, and potentially autoimmune conditions. The widespread adoption of EC, particularly among younger users, poses a growing public health challenge. As the popularity of vaping continues to rise, these immunological disruptions could result in increased healthcare burdens in the future, with higher rates of infections, chronic inflammatory diseases, and immune system-related disorders among those who begin using e-cigarettes at a young age. Understanding the full scope of EC-related health risks is essential for informing public health policies and protecting future generations from the potential long-term effects of vaping.
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Affiliation(s)
- Katarzyna Zima
- Department of Physiology, Medical University of Gdansk, Debinki 1, 80-211, Gdansk, Poland.
| | - Aleksandra Bogucka
- Department of Physiology, Medical University of Gdansk, Debinki 1, 80-211, Gdansk, Poland
| | - Miłosz Wojtas
- Department of Physiology, Medical University of Gdansk, Debinki 1, 80-211, Gdansk, Poland
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Kobayashi F, Saraya T, Kurokawa N, Aso J, Yamada S, Nakajima K, Doi K, Akizawa T, Takagi R, Ishikawa N, Kasuga K, Saito M, Yamaguchi C, Nunokawa H, Nakamoto Y, Ishida M, Sada M, Nakamoto K, Takata S, Ishii H. Predictors of Severe Coughing and Its Impact on Bronchoalveolar Lavage and Transbronchial Lung Biopsy in Patients with Diffuse Lung Disease: Evaluation of Bronchoscopy Safety. J Clin Med 2025; 14:893. [PMID: 39941564 PMCID: PMC11818121 DOI: 10.3390/jcm14030893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2024] [Revised: 01/22/2025] [Accepted: 01/25/2025] [Indexed: 02/16/2025] Open
Abstract
Background/Objectives: Bronchoscopy is an invasive procedure, and patient coughing during the examination has been reported to cause significant distress. This study aimed to identify predictors of coughing severity and assess its impact on the procedure during bronchoalveolar lavage (BAL) and transbronchial lung biopsy (TBLB). Methods: We conducted a prospective study involving 119 consecutive patients with diffuse lung disease who underwent BAL and TBLB at Kyorin University Hospital from April 2019 to December 2023. Cough severity was scored on a scale of 0 to 3, with scores of 0-1 considered mild and 2-3 considered severe. Multivariate logistic regression analysis was performed to identify factors associated with severe coughing during the procedure. Results: Severe coughing was significantly associated with Grade 2 or higher bleeding (OR 6.230, 95% CI 2.220-17.400, p < 0.001), fewer TBLB specimens collected (OR 0.708, 95% CI 0.530-0.945, p = 0.019), and pre-procedural dyspnea (OR 2.560, 95% CI 1.110-5.870, p = 0.027). Conclusions: Severe coughing during bronchoscopy is associated with increased bleeding and reduced specimen collection. For patients with pre-procedural dyspnea, proactive cough management may improve procedural safety and outcomes.
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Affiliation(s)
| | - Takeshi Saraya
- Department of Respiratory Medicine, Faculty of Medicine, Kyorin University, 6-20-2 Shinkawa, Mitaka City 181-8611, Tokyo, Japan; (F.K.); (N.K.); (J.A.); (S.Y.); (K.N.); (K.D.); (T.A.); (R.T.); (N.I.); (K.K.); (M.S.); (C.Y.); (H.N.); (Y.N.); (M.I.); (M.S.); (K.N.); (S.T.); (H.I.)
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Steiner J, Steuernagel L, Drakopanagiotakis F, Bonelis K, Steiropoulos P. A Scoping Review of Eosinophilic Pneumonia and Antidepressants: An Association Not to Be Overlooked. Diseases 2025; 13:13. [PMID: 39851477 PMCID: PMC11764640 DOI: 10.3390/diseases13010013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2024] [Revised: 01/09/2025] [Accepted: 01/10/2025] [Indexed: 01/26/2025] Open
Abstract
Background: Eosinophilic pneumonias denote a rare condition, wherein infiltrating eosinophilic granulocytes accumulate within the lung parenchyma. Although eosinophilic pneumonias may be idiopathic, they are also associated with secondary causes. More than 110 medications have been linked to eosinophilic pneumonia, including several antidepressants. This review presents an analysis of case reports of eosinophilic pneumonia correlated to antidepressants. Objectives: The objectives of this study are to provide a contemporary overview of the literature delineating eosinophilic pneumonia as a potential sequela of antidepressant medication treatment, and to discuss possible pathogenetic mechanisms linking antidepressants to eosinophilic pneumonia. Methods and Data Selection: A literature search was performed in PubMed and Scopus databases from 1963 to October 2024. The search strategy used the terms "eosinophilic pneumonia AND antidepressants". Sources included in this review were screened for relevance, focusing on references discussing eosinophilic pneumonia associated with any class of antidepressants. Case reports meeting the diagnostic criteria for acute eosinophilic pneumonia (AEP) or chronic eosinophilic pneumonia (CEP) were included in the review. Clinical, epidemiological, laboratory, radiology and bronchoscopy data, implicated antidepressant and dosage, and therapeutic interventions were reported. Results: This study found that various types of antidepressants are associated with AEP and CEP. The clinical presentation ranges from mild symptoms to respiratory failure and intubation. Outcomes were favorable in most cases, with complete remission achieved after discontinuation of the causative drug and, in severe cases, a short course of corticosteroids. Conclusions: Although a rare cause, antidepressants may lead to eosinophilic pneumonia, and should be considered in the differential diagnosis of unexplained pulmonary infiltrates. Clinical suspicion must be aroused, as early recognition would prevent unnecessary work-up and navigation of the diagnosis.
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Affiliation(s)
- Jaron Steiner
- Charité University Hospital, 10117 Berlin, Germany; (J.S.); (L.S.)
| | | | - Fotios Drakopanagiotakis
- Department of Pneumonology, Medical School, Democritus University of Thrace, University General Hospital Dragana, 68100 Alexandroupolis, Greece; (K.B.); (P.S.)
| | - Konstantinos Bonelis
- Department of Pneumonology, Medical School, Democritus University of Thrace, University General Hospital Dragana, 68100 Alexandroupolis, Greece; (K.B.); (P.S.)
| | - Paschalis Steiropoulos
- Department of Pneumonology, Medical School, Democritus University of Thrace, University General Hospital Dragana, 68100 Alexandroupolis, Greece; (K.B.); (P.S.)
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8
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Le L, Narula N, Zhou F, Smereka P, Ordner J, Theise N, Moore WH, Girvin F, Azour L, Moreira AL, Naidich DP, Ko JP. Diseases Involving the Lung Peribronchovascular Region: A CT Imaging Pathologic Classification. Chest 2024; 166:802-820. [PMID: 38909953 DOI: 10.1016/j.chest.2024.05.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 04/12/2024] [Accepted: 05/13/2024] [Indexed: 06/25/2024] Open
Abstract
TOPIC IMPORTANCE Chest CT imaging holds a major role in the diagnosis of lung diseases, many of which affect the peribronchovascular region. Identification and categorization of peribronchovascular abnormalities on CT imaging can assist in formulating a differential diagnosis and directing further diagnostic evaluation. REVIEW FINDINGS The peribronchovascular region of the lung encompasses the pulmonary arteries, airways, and lung interstitium. Understanding disease processes associated with structures of the peribronchovascular region and their appearances on CT imaging aids in prompt diagnosis. This article reviews current knowledge in anatomic and pathologic features of the lung interstitium composed of intercommunicating prelymphatic spaces, lymphatics, collagen bundles, lymph nodes, and bronchial arteries; diffuse lung diseases that present in a peribronchovascular distribution; and an approach to classifying diseases according to patterns of imaging presentations. Lung peribronchovascular diseases can appear on CT imaging as diffuse thickening, fibrosis, masses or masslike consolidation, ground-glass or air space consolidation, and cysts, acknowledging that some diseases may have multiple presentations. SUMMARY A category approach to peribronchovascular diseases on CT imaging can be integrated with clinical features as part of a multidisciplinary approach for disease diagnosis.
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Affiliation(s)
- Linda Le
- Department of Radiology, NYU Langone Health; NYU Grossman School of Medicine, New York, NY
| | - Navneet Narula
- Department of Pathology, NYU Langone Health; NYU Grossman School of Medicine, New York, NY
| | - Fang Zhou
- Department of Pathology, NYU Langone Health; NYU Grossman School of Medicine, New York, NY
| | - Paul Smereka
- Department of Radiology, NYU Langone Health; NYU Grossman School of Medicine, New York, NY
| | - Jeffrey Ordner
- Department of Pathology, NYU Langone Health; NYU Grossman School of Medicine, New York, NY
| | - Neil Theise
- Department of Pathology, NYU Langone Health; NYU Grossman School of Medicine, New York, NY
| | - William H Moore
- Department of Radiology, NYU Langone Health; NYU Grossman School of Medicine, New York, NY
| | - Francis Girvin
- Department of Diagnostic Radiology, Weill Cornell Medicine, New York, NY
| | - Lea Azour
- Department of Radiology, NYU Langone Health; NYU Grossman School of Medicine, New York, NY; Department of Radiological Sciences, UCLA David Geffen School of Medicine, Los Angeles, CA
| | - Andre L Moreira
- Department of Pathology, NYU Langone Health; NYU Grossman School of Medicine, New York, NY
| | - David P Naidich
- Department of Radiology, NYU Langone Health; NYU Grossman School of Medicine, New York, NY
| | - Jane P Ko
- Department of Radiology, NYU Langone Health; NYU Grossman School of Medicine, New York, NY.
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9
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Vural Solak GT, Aksu K, Akkale O, Telli O, Celik Tuglu H, Dindar Celik F, Yagdiran M. The long-term outcomes of mepolizumab treatment at 100 mg dose on idiopathic chronic eosinophilic pneumonia: A real-life experience. Allergy Asthma Proc 2024; 45:e46-e53. [PMID: 38982601 DOI: 10.2500/aap.2024.45.240029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2024]
Abstract
Background: The standard therapeutic regimen for idiopathic chronic eosinophilic pneumonia (ICEP) involves the administration of oral corticosteroids (OCS). However, a notable proportion of individuals experience recurrent episodes after the tapering or cessation of OCS during the course of ICEP. There has been a growing interest in exploring alternative treatment modalities for patients with ICEP at heightened risk of relapse. Objective: The aim of this study was to assess the efficacy of mepolizumab at a dose of 100 mg administered every 4 weeks in preventing relapses of ICEP and its impact on the clinical outcomes. Methods: This retrospective clinical observational study used real-world data to assess the impact of mepolizumab on patients diagnosed with ICEP accompanied by severe asthma. Demographic information and clinical characteristics were extracted from medical records. The study examined the effect of mepolizumab on the annual relapse rate, OCS dose, eosinophil count, and respiratory function parameters. Results: All patients included in the study, with a median (range) follow-up period of 19 months (4-40 months), the annual relapse rate decreased from 0.33 to 0 after the initiation mepolizumab. In addition, the maintenance OCS dose, expressed in methylprednisolone equivalents, declined from 4 mg/day to 0 mg/day. A reduction in the blood eosinophil count was observed, alongside a partial improvement in respiratory function test results among the patients. Conclusıon: A dose regimen of 100 mg of mepolizumab administered every 4 weeks emerges as a promising and well-tolerated therapeutic approach for averting relapses of ICEP.
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Bouhamdi A, Saddouki F, Alami B, Serraj M, Biaz M, Benjelloun MC, Amara B. Radioclinical Profile of Eosinophilic Lung: A Case Series. Cureus 2024; 16:e62579. [PMID: 39036186 PMCID: PMC11258676 DOI: 10.7759/cureus.62579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2024] [Indexed: 07/23/2024] Open
Abstract
In this study, we present findings from an analysis of 17 patients diagnosed with eosinophilic lung disease, with a majority (64.70%) being male. The average age of the patients was 54 ± 13.22 years. A history of uncontrolled asthma was noted in nine cases. The clinical picture was characterized by persistent dyspnea and cough. Blood hypereosinophilia was present in all cases, with a median of 1770 cells/ul. Two patients had a pulmonary eosinophilia greater than 25%. Radiological findings were consistent with diffuse bilateral ground-glass opacities or areas of consolidation in the majority of cases. The main etiologies identified were chronic eosinophilic pneumonia (12 cases), followed by eosinophilic granulomatosis with polyangiitis (3 cases), idiopathic hypereosinophilic syndrome (1 case) and drug-induced hypereosinophilia (1 case). All patients were treated with systemic corticosteroids, with the addition of immunosuppressive therapy necessary in three cases. Notably, five relapses were recorded after corticosteroid therapy was stopped.
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Affiliation(s)
- Abir Bouhamdi
- Pneumology Department, Hassan II University Hospital, Sidi Mohamed Ben Abdellah University, Fez, MAR
| | - Fatima Saddouki
- Radiology Department, Hassan II University Hospital, Sidi Mohamed Ben Abdellah University, Fez, MAR
| | - Badreddine Alami
- Radiology Department, Hassan II University Hospital, Sidi Mohamed Ben Abdellah University, Fez, MAR
| | - Mounia Serraj
- Pneumology Department, Hassan II University Hospital, Sidi Mohamed Ben Abdellah University, Fez, MAR
| | - Mohamed Biaz
- Pneumology Department, Hassan II University Hospital, Sidi Mohamed Ben Abdellah University, Fez, MAR
| | - Mohamed Chakib Benjelloun
- Pneumology Department, Hassan II University Hospital, Sidi Mohamed Ben Abdellah University, Fez, MAR
| | - Bouchra Amara
- Pneumology Department, Hassan II University Hospital, Sidi Mohamed Ben Abdellah University, Fez, MAR
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11
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Thomas M, Hameed M, Alhadad S, Haq IU. Heated tobacco product (IQOS) induced pulmonary infiltrates. Respir Med Case Rep 2024; 49:102026. [PMID: 38712315 PMCID: PMC11070754 DOI: 10.1016/j.rmcr.2024.102026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 03/28/2024] [Accepted: 04/26/2024] [Indexed: 05/08/2024] Open
Abstract
Background Heated tobacco products (HTPs) have been marketed as safer alternatives to conventional cigarettes, but emerging evidence suggests potential respiratory risks. We present a case of pulmonary complications associated with IQOS, a popular HTP, contributing to the growing understanding of these risks. Case description A 40-year-old chronic smoker switched to IQOS, consuming 1.5 packs per day. He presented with incidental chest radiographic abnormalities and peripheral eosinophilia. Computed tomography of chest revealed pulmonary nodules and ground glass opacities. Bronchoscopy indicated mild eosinophilia. After ruling out other causes, a lung biopsy was recommended but declined. Discontinuation of IQOS led to symptom resolution and radiographic improvement. This case adds to a limited literature on HTP-induced lung injury, with a unique presentation and favorable response to cessation. Conclusions The case highlights potential pulmonary complications and the first describing an organizing pattern of lung injury associated with IQOS use, emphasizing the importance of recognizing and discontinuing HTPs in patients with respiratory symptoms or radiographic abnormalities. Further research is needed to elucidate the mechanisms underlying the harmful effects of HTPs and inform public health policies. This case underscores the importance of monitoring and educating individuals about the potential risks of HTPs to respiratory health, especially in the context of smokers switching to these products.
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Affiliation(s)
- Merlin Thomas
- Department of Chest, Hamad General Hospital, Doha, Qatar
| | - Mansoor Hameed
- Department of Chest, Hamad General Hospital, Doha, Qatar
- Department of Clinical Medicine, Weill Cornell Medicine -Qatar, Qatar
| | | | - Irfan Ul Haq
- Department of Chest, Hamad General Hospital, Doha, Qatar
- Department of Clinical Medicine, Weill Cornell Medicine -Qatar, Qatar
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12
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Carbone RG, Puppo F, Mattar E, Roden AC, Hirani N. Acute and chronic eosinophilic pneumonia: an overview. Front Med (Lausanne) 2024; 11:1355247. [PMID: 38711783 PMCID: PMC11070545 DOI: 10.3389/fmed.2024.1355247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 04/05/2024] [Indexed: 05/08/2024] Open
Abstract
Acute and chronic eosinophilic pneumonia (AEP and CEP) include a group of rare interstitial lung diseases characterized by peripheral blood eosinophilia, increased eosinophils in bronchoalveolar lavage fluid, or eosinophilic infiltration of lung parenchyma. AEP is characterized by rapid onset, fast response to steroid treatment, and no relapse. CEP is characterized by marked tissue and peripheral blood eosinophilia, rapid response to steroid therapy, and tendency to disease recurrence. In addition, we briefly describe other eosinophilic lung diseases that must be considered in differential diagnosis of AEP and CEP. Eosinophilic pneumonias may be idiopathic or due to known causes such as medications or environmental exposure. At variance with previous reviews on this topic, a particular look in this overview was directed at pathological findings and radiological patterns.
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Affiliation(s)
| | - Francesco Puppo
- Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Eduardo Mattar
- Cardiothoracic Imaging, University of Washington, Seattle, WA, United States
| | - Anja C. Roden
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States
| | - Nikhil Hirani
- Center for Inflammation Research, The Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
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13
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Chessell C, Rabuszko L, Richardson D, Llewellyn C. Factors associated with the sexual transmission of Strongyloides stercoralis in men who have sex with men: A systematic review. J Eur Acad Dermatol Venereol 2024; 38:673-679. [PMID: 38013501 DOI: 10.1111/jdv.19664] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 10/09/2023] [Indexed: 11/29/2023]
Abstract
Strongyloides stercoralis is a parasitic worm with a complex life cycle and can cause significant morbidity, including a proctocolitis and life-threatening hyperinfection syndrome. Limited reports from non-endemic areas, including in men who have sex with men (MSM), suggest sexual transmission of S. stercoralis. In this systematic review of the published literature, we aimed to explore the associated factors of S. stercoralis in MSM. We systematically searched three bibliographical databases (MEDLINE, CINAHL and EMBASE) up to November 2022. We used a two-stage process to assess eligibility: the primary author conducted an initial screen of abstracts, and then three authors conducted independent full manuscripts to determine the final eligible manuscripts. We only included manuscripts written in English that contained data on specific factors associated with sexual transmission in MSM. We used the STROBE checklist to assess the risk of bias and synthesized the narrative data using the SWiM method. Seven manuscripts were eligible for this review (four case reports, one case series, one cross-sectional study and one experimental study), which included 22 individuals from Europe and the Americas. From these studies, S. stercoralis in MSM was associated with living with HIV (including having a low CD4 count and not using antiretrovirals), having a concomitant sexually transmitted infection (Chlamydia trachomatis, Neisseria gonorrhoeae, Treponema pallidum and hepatitis C) and a concomitant (sexually transmitted) protozoal infection (Entamoeba histolytica, Giardia lamblia), travel to the S. stercoralis endemic area, multiple sexual partners from endemic areas, oro-anal sexual contact and chemsex. Although limited by the number of cases in the literature, we have highlighted some possible biological and behavioural risk factors associated with the sexual transmission of S. stercoralis in MSM that could be used to both target future research and S. stercoralis public health control interventions.
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Affiliation(s)
- Callum Chessell
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, UK
| | - Lucy Rabuszko
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, UK
| | - Daniel Richardson
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, UK
- Department of Sexual Health and HIV, University Hospitals Sussex NHS Foundation Trust, Brighton, UK
| | - Carrie Llewellyn
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, UK
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14
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Morikawa K, Toyoshima M, Koda K, Kamiya Y, Suda T. Cryptogenic organizing pneumonia after withdrawal of systemic corticosteroids for chronic eosinophilic pneumonia and severe asthma under benralizumab treatment. Respir Investig 2024; 62:231-233. [PMID: 38224635 DOI: 10.1016/j.resinv.2023.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 11/21/2023] [Accepted: 12/22/2023] [Indexed: 01/17/2024]
Abstract
A 79-year-old woman with severe asthma developed chronic eosinophilic pneumonia (CEP). After CEP resolved with oral prednisolone at 30 mg/day, prednisolone was tapered and discontinued under introduction of benralizumab for her severe asthma. However, 8 weeks later, symptoms and bilateral patchy infiltrates on chest radiography appeared. Lymphocytosis without eosinophilia was seen in bronchoalveolar lavage fluids, and transbronchial biopsy indicated organizing pneumonia. Cryptogenic organizing pneumonia (COP) was diagnosed and resolved with prednisolone at 30 mg/day. Prednisolone was tapered to 3 mg/day without relapse of CEP or COP. This case suggests the overlap and similar pathogenesis of CEP and COP.
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Affiliation(s)
- Keisuke Morikawa
- Department of Respiratory Medicine, Hamamatsu Rosai Hospital, Hamamatsu, Shizuoka, 430-8525, Japan
| | - Mikio Toyoshima
- Department of Respiratory Medicine, Hamamatsu Rosai Hospital, Hamamatsu, Shizuoka, 430-8525, Japan.
| | - Keigo Koda
- Department of Respiratory Medicine, Hamamatsu Rosai Hospital, Hamamatsu, Shizuoka, 430-8525, Japan
| | - Yosuke Kamiya
- Department of Respiratory Medicine, Hamamatsu Rosai Hospital, Hamamatsu, Shizuoka, 430-8525, Japan
| | - Takafumi Suda
- Second Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, 431-3192, Japan
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15
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Vernon-Elliot J, Prasad JD, Bonney A. Critical deterioration of chronic eosinophilic pneumonia during pregnancy. BMJ Case Rep 2024; 17:e259019. [PMID: 38395471 PMCID: PMC10895239 DOI: 10.1136/bcr-2023-259019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2024] Open
Abstract
Chronic eosinophilic pneumonia (CEP) is a rare, idiopathic interstitial lung disease characterised by the accumulation of eosinophils in the pulmonary interstitia and alveoli. Patients with CEP respond well to systemic corticosteroid therapy and infrequently progress to end-stage lung disease. We report a case of a woman in her 40s with previously stable, steroid-responsive CEP who experienced a critical deterioration of her CEP at 25 weeks of gestation during her third pregnancy. The patient was admitted to the intensive care unit due to respiratory failure requiring intubation and mechanical ventilation. Follow-up investigation revealed advanced fibrotic lung disease requiring long-term oxygen therapy and referral for double lung transplantation. While CEP infrequently advances to permanent parenchymal damage, this case demonstrates the potential for severe exacerbations in the setting of pregnancy and highlights pregnancy as a potential risk factor for disease progression, reinforcing the need for further research to define optimal monitoring and treatment strategies.
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Affiliation(s)
- Jake Vernon-Elliot
- Melbourne Medical School, The University of Melbourne, Parkville, Victoria, Australia
| | - Jyotika Devi Prasad
- Department of Respiratory and Sleep Medicine, The Royal Melbourne Hospital, Parkville, Victoria, Australia
- Respiratory Department, Alfred Health, Melbourne, Victoria, Australia
| | - Asha Bonney
- Department of Respiratory and Sleep Medicine, The Royal Melbourne Hospital, Parkville, Victoria, Australia
- Department of Medicine, The University of Melbourne, Parkville, Victoria, Australia
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16
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Murillo AD, Castrillon AI, Serrano CD, Fernandez-Trujillo L. Monoclonal antibodies in idiopathic chronic eosinophilic pneumonia: a scoping review. BMC Pulm Med 2024; 24:74. [PMID: 38331769 PMCID: PMC10851541 DOI: 10.1186/s12890-024-02868-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 01/18/2024] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND Idiopathic chronic eosinophilic pneumonia (ICEP) is a rare disease characterized by pulmonary radiological alterations, peripheral eosinophilia, and demonstrated pulmonary eosinophilia. Oral steroids (OSs) are the standard management, but relapses occur in up to 50% of patients during the decrease or suspension of steroids, usually requiring reinitiation of treatment, exposing patients to secondary events derived from the management. Management with monoclonal antibodies has been proposed in these cases to control the disease and limit the secondary effects. The objective is to describe the extent and type of evidence regarding the use of monoclonal antibodies for ICEP. METHODS A panoramic review of the literature was performed. Observational and experimental studies of pediatric and adult populations that managed recurrent ICEP with monoclonal antibodies were included. Data search, selection, and extraction were performed by two independent reviewers. RESULTS 937 studies were found. After applying the inclusion and exclusion criteria, 37 titles remained for the final analysis: a retrospective, observational, real-life study, two case series publications, and 34 case reports published in academic poster sessions and letters to the editor. In general, the use of monoclonal antibodies approved for severe asthma could be useful for the control of ICEP, since most of the results show a good response for clinical and radiological outcomes. Biological drugs seem to be a safer option for controlling relapses in ICEP, allowing lowering/suspension of OSs, and sometimes replacing them in patients intolerant to them, patients with significant comorbidities, and patients who have already developed adverse events. CONCLUSION The extent of the evidence supporting management of ICEP with monoclonal antibodies against IL-5 and IgE (omalizumab) is limited, but it could be promising in patients who present frequent relapses, in cortico-dependent individuals, or in patients in whom the use of steroids is contraindicated. The extent of the evidence for management with dupilumab is more limited. Studies with better design and structure are needed to evaluate quality of life and outcomes during a clear follow-up period. To our knowledge, this is the first scoping review of the literature showing the extent of the evidence for the management of ICEP with monoclonal antibodies.
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Affiliation(s)
- Andrea Dionelly Murillo
- Department of Internal Medicine, Allergology Service, Fundación Valle del Lili, Carrera 98 # 18-49, Cali, 760032, Colombia
- Faculty of Health Sciences, Universidad Icesi, Calle 18 # 122-135, Cali, 760032, Colombia
| | - Ana Isabel Castrillon
- Clinical Research Center, Fundación Valle del Lili, Carrera 98 # 18-49, Cali, 760032, Colombia
| | - Carlos Daniel Serrano
- Department of Internal Medicine, Allergology Service, Fundación Valle del Lili, Carrera 98 # 18-49, Cali, 760032, Colombia
- Faculty of Health Sciences, Universidad Icesi, Calle 18 # 122-135, Cali, 760032, Colombia
| | - Liliana Fernandez-Trujillo
- Faculty of Health Sciences, Universidad Icesi, Calle 18 # 122-135, Cali, 760032, Colombia.
- Department of Internal Medicine, Pulmonology Service, Interventional Pulmonology. Fundacion Valle del Lili, Av. Simón Bolívar. Carrera 98 # 18-49. Torre 6, 4th Floor, Cali, Colombia.
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17
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Nakashima D, Mori E, Otori N. A case of recurrent chronic eosinophilic pneumonia after switching from benralizumab to dupilumab. Respir Med Case Rep 2024; 47:101968. [PMID: 38274702 PMCID: PMC10808983 DOI: 10.1016/j.rmcr.2023.101968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 10/30/2023] [Accepted: 12/21/2023] [Indexed: 01/27/2024] Open
Abstract
Dupilumab inhibits interleukin-4Rα and suppresses type 2 inflammation. Careful administration of dupilumab is required because it increases the blood eosinophil count secondary to a decrease in local eosinophil counts, sometimes resulting in eosinophilic complications. We herein report a case of recurrent chronic eosinophilic pneumonia after switching from benralizumab to dupilumab. A 54-year-old man with a history of eosinophilic pneumonia presented to our hospital with symptoms of cough, fever, and phlegm production six months after beginning dupilumab administration for recurrent chronic rhinosinusitis. When using dupilumab, it is essential to carefully monitor patients' eosinophil trends and pulmonary symptoms.
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Affiliation(s)
| | - Eri Mori
- Corresponding author. 3-25-8, Nishishimbashi, Minato-ku, Tokyo 105-8461, Japan
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18
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Misaki Y, Hayashi Y, Shirata M, Terada K, Yoshizawa A, Sakamoto R, Ikezoe K, Tanizawa K, Handa T, Hirai T. Resolution of Eosinophilic Pneumonia after Coronavirus Disease 2019 without Systemic Corticosteroids. Intern Med 2023; 62:3223-3230. [PMID: 37587039 PMCID: PMC10686740 DOI: 10.2169/internalmedicine.1648-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 07/02/2023] [Indexed: 08/18/2023] Open
Abstract
Pulmonary and extrapulmonary complications after coronavirus disease 2019 (COVID-19) have been major public health concerns during the COVID-19 pandemic. Although post-COVID-19 pulmonary manifestations cover a wide spectrum, eosinophilic pneumonia (EP) has rarely been reported. To date, only four cases of EP potentially triggered by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection have been reported, all of which required systemic corticosteroid therapy. We herein report the first case of post-COVID-19 EP resolution without systemic corticosteroid therapy. We also review the literature regarding EP associated with SARS-CoV-2 infection and vaccination.
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Affiliation(s)
- Yumiko Misaki
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Japan
| | - Yusuke Hayashi
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Japan
| | - Masahiro Shirata
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Japan
- Department of Respiratory Medicine, Kyoto Preventive Medical Center, Japan
| | - Kazuhiro Terada
- Department of Diagnostic Pathology, Graduate School of Medicine, Kyoto University, Japan
| | - Akihiko Yoshizawa
- Department of Diagnostic Pathology, Graduate School of Medicine, Kyoto University, Japan
| | - Ryo Sakamoto
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, Japan
| | - Kohei Ikezoe
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Japan
| | - Kiminobu Tanizawa
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Japan
| | - Tomohiro Handa
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Japan
- Department of Advanced Medicine for Respiratory Failure, Graduate School of Medicine, Kyoto University, Japan
| | - Toyohiro Hirai
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Japan
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19
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Atsumi K, Hisakane K, Mikami E, Suzuki T, Matsuki S, Seike M, Hirose T. Minimal effective dose of maintenance steroid therapy for relapse of cryptogenic organizing pneumonia. Respir Med 2023; 218:107390. [PMID: 37598895 DOI: 10.1016/j.rmed.2023.107390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 05/07/2023] [Accepted: 08/14/2023] [Indexed: 08/22/2023]
Abstract
BACKGROUND Long-term maintenance steroid therapy (MST) is frequently required for repeated relapses of cryptogenic organizing pneumonia (COP); however, the optimal minimal dose has not been clarified. Therefore, this study evaluated the minimal MST dose required to prevent repeated relapses and identify relapse predictors. METHODS We retrospectively reviewed the medical records of patients with steroid-treated COP and compared background factors between the non-relapse and relapse groups. We also reviewed the treatment course in the relapse group and determined the minimal effective steroid dose based on the MST dose at relapse events and the current relapse prevention dose. RESULTS In total, 48 patients were identified, including 27 (56%) in the non-relapse group and 21 (44%) in the relapse group. Receiver operating characteristic curve analysis identified prednisolone at 5 mg/day as the optimal cut-off value in the relapse group. Relapse-free time in patients with relapsed COP was significantly longer in the MST dose ≥5 mg/day group than in the <5 mg/day group (log-rank P = 0.003; hazard ratio, 0.19; 95% confidence interval [CI], 0.04-0.60). Multivariate logistic regression analysis demonstrated that a high eosinophil percentage and CD4/CD8 ratio in bronchoalveolar lavage fluid (BALF) were predictors of relapse (odds ratio [OR], 1.12; 95% CI, 1.02-1.23; P = 0.008 and OR, 3.87; 95% CI, 1.29-11.6; P = 0.008, respectively). CONCLUSIONS Our results indicate that 5 mg/day of prednisolone may be the minimal effective dose for preventing repeated relapses, and a high BALF eosinophil percentage and CD4/CD8 ratio are independent predictors of relapse.
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Affiliation(s)
- Kenichiro Atsumi
- Department of Pulmonary Medicine and Medical Oncology, Nippon Medical School Tama Nagayama Hospital, 1-7-1 Nagayama, Tama-shi, Tokyo, 206-8512, Japan.
| | - Kakeru Hisakane
- Department of Pulmonary Medicine and Medical Oncology, Nippon Medical School Tama Nagayama Hospital, 1-7-1 Nagayama, Tama-shi, Tokyo, 206-8512, Japan
| | - Erika Mikami
- Department of Pulmonary Medicine and Medical Oncology, Nippon Medical School Tama Nagayama Hospital, 1-7-1 Nagayama, Tama-shi, Tokyo, 206-8512, Japan
| | - Takahiro Suzuki
- Department of Pulmonary Medicine and Medical Oncology, Nippon Medical School Tama Nagayama Hospital, 1-7-1 Nagayama, Tama-shi, Tokyo, 206-8512, Japan
| | - Satoru Matsuki
- Department of Pulmonary Medicine and Medical Oncology, Nippon Medical School Tama Nagayama Hospital, 1-7-1 Nagayama, Tama-shi, Tokyo, 206-8512, Japan
| | - Masahiro Seike
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Takashi Hirose
- Department of Pulmonary Medicine and Medical Oncology, Nippon Medical School Tama Nagayama Hospital, 1-7-1 Nagayama, Tama-shi, Tokyo, 206-8512, Japan
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20
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Hatsukawa H, Ishikawa M, Hirai T, Endo K, Saito E, Matsumoto H, Okazaki K. Comorbidity of eosinophilic chronic rhinosinusitis in chronic eosinophilic pneumonia. Respirol Case Rep 2023; 11:e01236. [PMID: 37854459 PMCID: PMC10579627 DOI: 10.1002/rcr2.1236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 10/07/2023] [Indexed: 10/20/2023] Open
Abstract
We aimed to elucidate details of comorbid chronic rhinosinusitis (CRS) in chronic eosinophilic pneumonia (CEP) under the collaboration between otolaryngologists and pulmonologists in a prospective study. The CEP diagnosis was performed by pulmonologists based on clinical symptoms, laboratory findings, and/or eosinophilia detected in bronchoalveolar lavage. All patients were referred to otolaryngologists before undergoing oral corticosteroid treatment for CEP. Ten CEP cases visited to otolaryngologists. All cases showed bilateral sinonasal inflammation in computed tomography (CT), indicating comorbid CRS. Nasal polyps (NPs) were observed in 50% of patients on endoscopy. Eighty percent of patients were diagnosed with eosinophilic CRS. In blood eosinophil levels and the mucosal eosinophil count, there were no significant differences between CRS without and with NPs. In Lund-Mackay CT total scores, among-individual variability was observed in CRS with NPs. The collaboration revealed blood/sinonasal eosinophilia and the variability in Lund-Mackay CT total scores as remarkable findings about the comorbid CRS.
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Affiliation(s)
- Hiroatsu Hatsukawa
- Department of Otolaryngology, Head and Neck SurgeryHyogo Prefectural Amagasaki General Medical CenterAmagasakiJapan
| | - Masaaki Ishikawa
- Department of Otolaryngology, Head and Neck SurgeryHyogo Prefectural Amagasaki General Medical CenterAmagasakiJapan
| | - Tomoyuki Hirai
- Department of Respiratory MedicineHyogo Prefectural Amagasaki General Medical CenterAmagasakiJapan
| | - Kazuo Endo
- Department of Respiratory MedicineHyogo Prefectural Amagasaki General Medical CenterAmagasakiJapan
| | - Emiko Saito
- Department of Respiratory MedicineHyogo Prefectural Amagasaki General Medical CenterAmagasakiJapan
| | - Hirotaka Matsumoto
- Department of Respiratory MedicineHyogo Prefectural Amagasaki General Medical CenterAmagasakiJapan
| | - Kouya Okazaki
- Department of Respiratory MedicineHyogo Prefectural Amagasaki General Medical CenterAmagasakiJapan
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21
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Ikedinobi MN, Gbujie E. Acute Versus Chronic Eosinophilic Pneumonia: A Case Report. Cureus 2023; 15:e46257. [PMID: 37908935 PMCID: PMC10615121 DOI: 10.7759/cureus.46257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2023] [Indexed: 11/02/2023] Open
Abstract
Eosinophilic pneumonia is a very rare form of interstitial lung disease. It is subdivided into acute and chronic types. Both types share some characteristics differences and similarities. We report two unique cases of acute eosinophilic pneumonia (AEP) and chronic eosinophilic pneumonia seen in 37- and 30-year-old males, respectively. Both cases occurred in the summer of the same year. There was no known association between the two patients except that they were both young males. We were able to compare the unique features of AEP and chronic eosinophilic pneumonia (CEP) and how these relate to the cases presented.
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Affiliation(s)
- Maureen N Ikedinobi
- Medicine, University of North Dakota School of Medicine and Health Sciences, Grand Forks, USA
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22
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De Albuquerque Monteiro I, Fernandes Moura P, Fernandes D, Carneiro JC, Teixeira S. A Case of Acute Eosinophilic Pneumonia Triggered by the SARS-CoV-2 Virus. Cureus 2023; 15:e38111. [PMID: 37252582 PMCID: PMC10211398 DOI: 10.7759/cureus.38111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2023] [Indexed: 05/31/2023] Open
Abstract
We report a case of acute eosinophilic pneumonia (AEP) triggered by the coronavirus disease 2019 (COVID-19) infection. A 60-year-old male with chronic sinusitis and tobacco use presented to the emergency department (ED) with an acute onset of dyspnea, non-productive cough, and fever. A diagnosis of moderate SARS-CoV-2 infection with bacterial superinfection was made. He was discharged on antibiotic therapy. One month later, due to the persistence of symptoms, he returned to the ED. At this time, blood analysis showed eosinophilia and a chest computed tomography scan showed bilateral diffuse infiltrative changes. He was admitted to the hospital for the study of eosinophilic disease. A lung biopsy was performed, which showed eosinophilic pneumonia. Corticotherapy was started with symptoms and peripheral eosinophilia resolution, and imaging improvement.
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Affiliation(s)
| | | | - Diana Fernandes
- Internal Medicine, Centro Hospitalar do Médio Ave, Vila Nova de Famalicão, PRT
| | | | - Sofia Teixeira
- Internal Medicine, Centro Hospitalar do Médio Ave, Vila Nova de Famalicão, PRT
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23
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Knoflach K, Rapp CK, Schwerk N, Carlens J, Wetzke M, Emiralioğlu N, Kiper N, Ring AM, Buchvald F, Manali E, Papiris S, Reu-Hofer S, Kappler M, Schieber A, Seidl E, Gothe F, Robinson PN, Griese M. Diffuse alveolar hemorrhage in children with interstitial lung disease: Determine etiologies! Pediatr Pulmonol 2023; 58:1106-1121. [PMID: 36588100 DOI: 10.1002/ppul.26301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 11/11/2022] [Accepted: 12/27/2022] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Diffuse alveolar hemorrhage (DAH) in children is a rare condition resulting from different underlying diseases. This study aimed at describing characteristics and diagnostic measures in children with ILD (children's interstitial lung disease, chILD) and DAH to improve the diagnostic approach by increasing clinician's awareness of diagnostic shortcomings. PATIENTS AND METHODS A retrospective data analysis of patients with ILD and DAH treated in our own or collaborating centers between 01/07/1997 and 31/12/2020 was performed. Data on clinical courses and diagnostic measures were systematically retrieved as case-vignettes and investigated. To assess suitability of diagnostic software-algorithms, the Human Phenotype Ontology (HPO) was revised and expanded to optimize conditions of its associated tool the "Phenomizer." RESULTS For 97 (74%) of 131 patients, etiology of pulmonary hemorrhage was clarified. For 34 patients (26%), no underlying condition was found (termed as idiopathic pulmonary hemorrhage, IPH). Based on laboratory findings or clinical phenotype/comorbidities, 20 of these patients were assigned to descriptive clusters: IPH associated with autoimmune features (9), eosinophilia (5), renal disease (3) or multiorgan involvement (3). For 14 patients, no further differentiation was possible. CONCLUSION Complete and sometimes repeated diagnostics are essential for establishing the correct diagnosis in children with DAH. We suggest assignment of patients with IPH to descriptive clusters, which may also guide further research. Digital tools such as the Phenomizer/HPO are promising, but need to be extended to increase diagnostic accuracy.
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Affiliation(s)
- Katrin Knoflach
- Department of Pediatrics, Dr. von Hauner Children's Hospital, University Hospital, Ludwig-Maximilians-University (LMU) Munich, Munich, Germany
| | - Christina Katharina Rapp
- Department of Pediatrics, Dr. von Hauner Children's Hospital, University Hospital, Ludwig-Maximilians-University (LMU) Munich, Munich, Germany
| | - Nicolaus Schwerk
- Department of Pediatrics, Pediatric Pulmonology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany.,German Center for Lung Research (DLZ), Partner Site Hannover (BREATH), Hanover, Germany
| | - Julia Carlens
- Department of Pediatrics, Pediatric Pulmonology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany
| | - Martin Wetzke
- Department of Pediatrics, Pediatric Pulmonology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany
| | - Nagehan Emiralioğlu
- Department of Pediatric Pulmonology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Nural Kiper
- Department of Pediatric Pulmonology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Astrid Madsen Ring
- Pediatric Pulmonary Service, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Frederik Buchvald
- Pediatric Pulmonary Service, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Effrosyni Manali
- Department of Respiratory Medicine, 'Attikon' University Hospital, Athens Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Spyros Papiris
- Department of Respiratory Medicine, 'Attikon' University Hospital, Athens Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Simone Reu-Hofer
- Institute of Pathology, University of Würzburg, Würzburg, Germany
| | - Matthias Kappler
- Department of Pediatrics, Dr. von Hauner Children's Hospital, University Hospital, Ludwig-Maximilians-University (LMU) Munich, Munich, Germany
| | - Alexandra Schieber
- Department of Pediatrics, Dr. von Hauner Children's Hospital, University Hospital, Ludwig-Maximilians-University (LMU) Munich, Munich, Germany
| | - Elias Seidl
- Department of Pediatrics, Dr. von Hauner Children's Hospital, University Hospital, Ludwig-Maximilians-University (LMU) Munich, Munich, Germany
| | - Florian Gothe
- Department of Pediatrics, Dr. von Hauner Children's Hospital, University Hospital, Ludwig-Maximilians-University (LMU) Munich, Munich, Germany
| | - Peter N Robinson
- The Jackson Laboratory for Genomic Medicine, Farmington, Connecticut, USA
| | - Matthias Griese
- Department of Pediatrics, Dr. von Hauner Children's Hospital, University Hospital, Ludwig-Maximilians-University (LMU) Munich, Munich, Germany.,German center for Lung Research (DLZ), Partner Site Munich, Munich, Germany
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24
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Hidden Comorbidities in Asthma: A Perspective for a Personalized Approach. J Clin Med 2023; 12:jcm12062294. [PMID: 36983294 PMCID: PMC10059265 DOI: 10.3390/jcm12062294] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 03/05/2023] [Accepted: 03/13/2023] [Indexed: 03/18/2023] Open
Abstract
Bronchial asthma is the most frequent inflammatory non-communicable condition affecting the airways worldwide. It is commonly associated with concomitant conditions, which substantially contribute to its burden, whether they involve the lung or other districts. The present review aims at providing an overview of the recent acquisitions in terms of asthma concomitant systemic conditions, besides the commonly known respiratory comorbidities. The most recent research has highlighted a number of pathobiological interactions between asthma and other organs in the view of a shared immunological background underling different diseases. A bi-univocal relationship between asthma and common conditions, including cardiovascular, metabolic or neurodegenerative diseases, as well as rare disorders such as sickle cell disease, α1-Antitrypsin deficiency and immunologic conditions with hyper-eosinophilia, should be considered and explored, in terms of diagnostic work-up and long-term assessment of asthma patients. The relevance of that acquisition is of utmost importance in the management of asthma patients and paves the way to a new approach in the light of a personalized medicine perspective, besides targeted therapies.
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Sharma S, Rojas H, Spano C, George-Varghese B, Liu T. Acute Eosinophilic Pneumonia Presenting as Altered Mental Status. J Emerg Med 2023; 64:502-505. [PMID: 37002159 DOI: 10.1016/j.jemermed.2023.02.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 01/08/2023] [Accepted: 02/17/2023] [Indexed: 03/31/2023]
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Bonnier A, Saha S, Shkolnik B, Saha BK. A comparative analysis of acute eosinophilic pneumonia associated with smoking and vaping. Am J Med Sci 2023; 365:315-317. [PMID: 36265655 DOI: 10.1016/j.amjms.2022.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 09/12/2022] [Accepted: 10/12/2022] [Indexed: 12/25/2022]
Affiliation(s)
- Alyssa Bonnier
- Department of Critical Care Nursing, Goldfarb School of Nursing, Barnes Jewish College, Saint Louis, Missouri, USA
| | - Santu Saha
- Department of Medicine, Saha Clinic, Bangladesh
| | - Boris Shkolnik
- Department of Pulmonary and Critical Care Medicine, Albany Medical Center, Albany, NY, USA
| | - Biplab K Saha
- Department of Pulmonary, Critical Care and Sleep Medicine, University of Florida, Gainesville, FL, USA..
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Wu C, Li Z, Wang C, Deng Z. Clinical characteristics, management, and outcome of eosinophilic pneumonia associated with daptomycin. Med Clin (Barc) 2023; 160:17-22. [PMID: 35840367 DOI: 10.1016/j.medcli.2022.03.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 03/22/2022] [Accepted: 03/29/2022] [Indexed: 01/13/2023]
Abstract
OBJECTIVE The association between daptomycin exposure and eosinophilic pneumonia (EP) is mainly based on case reports. The purpose of this study was to evaluate the clinical characteristics and provide more evidence for better identify and management of daptomycin-induced eosinophilic pneumonia in clinical practice. METHODS Literature from 1991 to October 31, 2021 on EP induced by daptomycin were collected for retrospective analysis. RESULTS A total of 47 patients (40 male and 7 female) from 35 studies were included. The median age was 67 years (range 28-89), and 78.7% of patients were ≥60 years. Daptomycin was mainly used in patients undergoing osteoarticular infections (63.8%). Typical initial symptoms were fever (91.5%), cough (55.3%) and dyspnea (59.6%). The median onset time of symptom was 3 weeks. EP recurred in 14.9% of patients after the re-administration of daptomycin, and 57.1% of EP recurred within 24h. Most cases were accompanied by marked accumulation of eosinophils in peripheral (41 cases) and/or bronchoalveolar lavage fluid (27 cases). The main radiological features were pulmonary infiltration, ground glass opacity or consolidation in CT/CXR. All patients had symptom resolution after discontinuation of daptomycin except for one patient died due to the progression of the primary disease, the median time to symptoms relief was 3 days. Corticosteroids have been shown to help symptoms relief in some cases (59.6%). CONCLUSION Daptomycin-induced eosinophilic pneumonia is a rare and serious complication. Physicians should consider eosinophilic pneumonia as a differential diagnosis when receiving daptomycin therapy, particularly in elderly male patients.
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Affiliation(s)
- Cuifang Wu
- Department of Pharmacy, The Third Xiangya Hospital, Central South University, Changsha, Hunan 410013, China
| | - Zuojun Li
- Department of Pharmacy, The Third Xiangya Hospital, Central South University, Changsha, Hunan 410013, China
| | - Chunjiang Wang
- Department of Pharmacy, The Third Xiangya Hospital, Central South University, Changsha, Hunan 410013, China
| | - Zhenzhen Deng
- Department of Pharmacy, The Third Xiangya Hospital, Central South University, Changsha, Hunan 410013, China.
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Asano K, Suzuki Y, Tanaka J, Kobayashi K, Kamide Y. Treatments of refractory eosinophilic lung diseases with biologics. Allergol Int 2023; 72:31-40. [PMID: 36333218 DOI: 10.1016/j.alit.2022.10.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 10/03/2022] [Accepted: 10/04/2022] [Indexed: 11/05/2022] Open
Abstract
Biologics targeting the molecules associated with type 2 inflammation have significantly improved the outcomes of patients with severe eosinophilic asthma and chronic rhinosinusitis with nasal polyps (CRSwNP). Chronic eosinophilic airway/lung diseases including chronic eosinophilic pneumonia, allergic bronchopulmonary aspergillosis/mycosis, eosinophilic bronchitis, and eosinophilic granulomatosis with polyangiitis share clinical features with eosinophilic asthma and CRPwNP, which are mostly adult-onset and may develop simultaneously or consecutively. These eosinophilic airway/lung diseases respond well to initial treatment with systemic corticosteroids, but often recur when the corticosteroids are tapered. The management of these "refractory" cases is an unmet need for clinicians. We first reviewed the standard treatments for these chronic eosinophilic airway/lung diseases, followed by the definition and prevalence of refractory diseases and the role of biologics in their management. The available evidence varies from case reports and case series to randomized control trials, depending on the type of disease; however, these studies provide not only a direction for clinical practice, but also insights into the pathophysiology of each disease. Physicians should discuss the efficacy and costs of biologics in patients with refractory eosinophilic airway/lung diseases to minimize not only the current symptoms, but future risks as well.
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Affiliation(s)
- Koichiro Asano
- Division of Pulmonary Medicine, Department of Medicine, Tokai University School of Medicine, Kanagawa, Japan.
| | - Yuzo Suzuki
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Shizuoka, Japan
| | - Jun Tanaka
- Division of Pulmonary Medicine, Department of Medicine, Tokai University School of Medicine, Kanagawa, Japan
| | - Konomi Kobayashi
- Division of Respiratory Medicine and Allergology, Department of Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Yosuke Kamide
- Clinical Research Center for Allergy and Rheumatology, Sagamihara National Hospital, Sagamihara, Japan
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Yasutomi M, Nitta S, Hayashi T, Yoshikawa T, Naito T, Ohshima Y. Ulcerative colitis developed after remission of eosinophilic pneumonia. Pediatr Int 2023; 65:e15486. [PMID: 36704868 DOI: 10.1111/ped.15486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 01/20/2023] [Accepted: 01/24/2023] [Indexed: 01/28/2023]
Affiliation(s)
- Motoko Yasutomi
- Department of Pediatrics, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Sachiyo Nitta
- Department of Pediatrics, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Taihei Hayashi
- Department of Pediatrics, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Toshihide Yoshikawa
- Department of Pediatrics, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Tatsushi Naito
- Second Department of Internal Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Yusei Ohshima
- Department of Pediatrics, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
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Bonnier A, Nida A, Chong WH, Saha S, Saha BK. Vaping Associated Acute Eosinophilic Pneumonia: A Clinical and Radiologic Mimicker of COVID-19. Prague Med Rep 2023; 124:283-292. [PMID: 37736951 DOI: 10.14712/23362936.2023.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/23/2023] Open
Abstract
Acute eosinophilic pneumonia (AEP) is a rare cause of respiratory failure. It is primarily a disease of smokers, either a new smoker or an existing one with a recent increase in cigarette consumption. Other risk factors include toxic gas exposure, inhalational illicit drugs, and smoking marijuana. AEP has also been reported in patients with e-cigarette or vaping associated lung injury (EVALI). We present the case of a 20-year-old male who presented to the hospital with acute respiratory failure. The patient has been vaping heavily for the past three months and started smoking three days before presenting to the emergency department. He was hypertensive, tachycardic, tachypneic, and required high-flow nasal cannula to maintain SpO2 > 92%. His condition deteriorated in the first 24 hours following hospitalization requiring noninvasive positive pressure ventilation. Bronchoalveolar lavage revealed an eosinophil count of 36%. Bronchoalveolar lavage (BAL) cytology revealed lipid-laden macrophages. He was diagnosed with AEP due to EVALI, and the patient was treated with high dose corticosteroid with subsequent improvement. Before the bronchoscopic evaluation, the clinical and radiologic findings were consistent with COVID-19, and the patient was tested twice for SARS-CoV-2 PCR. In the appropriate clinical setting, AEP should be considered in the differential diagnoses of community-acquired pneumonia, acute respiratory distress syndrome (ARDS), and COVID-19, especially in this pandemic era.
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Affiliation(s)
- Alyssa Bonnier
- Department of Critical Care Nursing, Goldfarb School of Nursing, Barnes Jewish College, Saint Louis, USA
| | - Anum Nida
- Department of Medicine, Ozarks Medical Center, West Plains, USA
| | - Woon Hean Chong
- Department of Intensive Care Medicine, Ng Teng Fong General Hospital, National University Health System, Singapore City, Singapore
| | - Santu Saha
- Department of Medicine, Saha Clinic, Lohagara, Narail, Bangladesh
| | - Biplab K Saha
- Department of Pulmonary, Critical Care and Sleep Medicine, University of Florida, Gainesville, USA.
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Sakakura S, Yamaguchi F, Abe T, Cho H, Shimizu S, Mase A, Shikama Y, Maruyama H. Pneumothorax with Eosinophilia is an Important Diagnostic Clue for Distinguishing Paragonimiasis from Chronic Eosinophilic Pneumonia: A Case Report. Infect Drug Resist 2023; 16:2429-2432. [PMID: 37138842 PMCID: PMC10149771 DOI: 10.2147/idr.s402392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 04/13/2023] [Indexed: 05/05/2023] Open
Abstract
The Paragonimus westermani infection is a parasitic foodborne infection that induces systemic symptoms with eosinophilia in humans. Here, we described pneumothorax in addition to pulmonary opacities with eosinophilia in a man with a positive P. westermani serology. He was misdiagnosed with chronic eosinophilic pneumonia (CEP) during the initial phase. Paragonimiasis can share similar clinical findings with CEP in cases where the worm is confined to the lungs. The findings of the current study suggest that paragonimiasis and CEP can be distinguished from each other by the presence of various symptoms. Notably, eosinophilia with pneumothorax should be an important diagnostic factor for paragonimiasis.
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Affiliation(s)
- Shunsuke Sakakura
- Department of Respiratory Medicine, Showa University Fujigaoka Hospital, Yokohama, Japan
| | - Fumihiro Yamaguchi
- Department of Respiratory Medicine, Showa University Fujigaoka Hospital, Yokohama, Japan
- Correspondence: Fumihiro Yamaguchi, Department of Respiratory Medicine, Showa University Fujigaoka Hospital, 1-30 Fujigaoka, Aoba-ku, Yokohama, 227-8501, Japan, Tel +81-45-971-1151, Email
| | - Takashi Abe
- Department of Respiratory Medicine, Showa University Fujigaoka Hospital, Yokohama, Japan
| | - Hidekazu Cho
- Department of Respiratory Medicine, Showa University Fujigaoka Hospital, Yokohama, Japan
| | - Shohei Shimizu
- Department of Respiratory Medicine, Showa University Fujigaoka Hospital, Yokohama, Japan
| | - Ayaka Mase
- Department of Respiratory Medicine, Showa University Fujigaoka Hospital, Yokohama, Japan
| | - Yusuke Shikama
- Department of Respiratory Medicine, Showa University Fujigaoka Hospital, Yokohama, Japan
| | - Haruhiko Maruyama
- Division of Parasitology, Department of Infectious Diseases, Graduate School of Medicine and Veterinary Medicine, University of Miyazaki, Miyazaki, Japan
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Angeletti G, Mazzolini M, Rocca A. Two years follow-up of relapsing eosinophilic pneumonia with concomitant severe asthma successfully treated with benralizumab: A case report and brief review of the literature. Respir Med Case Rep 2022; 41:101795. [PMID: 36579077 PMCID: PMC9791164 DOI: 10.1016/j.rmcr.2022.101795] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 12/12/2022] [Indexed: 12/15/2022] Open
Abstract
Relapsing eosinophilic pneumonia and severe eosinophilic asthma are rare and disabling diseases, which share common inflammatory backgrounds and often require long-term systemic steroid therapy. Benralizumab is a humanized antibody targeting IL-5 receptor that reduces corticosteroid dependence and flares up in severe eosinophilic asthma on long term. In this case report, successful treatment of eosinophilic pneumonia and severe eosinophilic asthma with benralizumab is described after a 2-year follow up, showing the promising results of this therapy for eosinophilic pneumonia management.
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Takeuchi N, Arai T, Sasaki Y, Akira M, Matsuda Y, Tachibana K, Kasai T, Inoue Y. Predictive factors for relapse in corticosteroid-treated patients with chronic eosinophilic pneumonia. J Thorac Dis 2022; 14:4352-4360. [PMID: 36524087 PMCID: PMC9745510 DOI: 10.21037/jtd-22-511] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 10/09/2022] [Indexed: 09/09/2024]
Abstract
BACKGROUND Chronic eosinophilic pneumonia (CEP) is an idiopathic disorder characterised by an abnormal and marked accumulation of eosinophils in the interstitium and alveolar spaces of the lungs. Systemic corticosteroid (CS) therapy leads to marked improvement. However, relapse is common in the clinical course, and the predictive factors for relapse of CEP are not well known. This study aimed to investigate predictive factors for relapse in CS-treated cases of CEP. METHODS We identified consecutive patients with CEP at our institution between 1999 and 2019. We retrospectively reviewed 36 CS-treated patients with CEP who underwent bronchoalveolar lavage (BAL) and high-resolution computed tomography (CT) at diagnosis. We examined relapse at least 1 year after the initiation of CS treatment. Statistical analysis included univariate and multivariate Cox proportional hazard regression analyses; P<0.05 was considered statistically significant. RESULTS The median (interquartile range) age at diagnosis was 59.5 years (47.8-70.0 years). This study included 13 men and 23 women. Twenty-five patients (69.4%) were never smokers and 15 (41.7%) had asthma. The peripheral blood eosinophil percentage was 35.0% (15.6-55.8%), and the BAL eosinophil percentage was 40.8% (10.7-68.5%). The median serum surfactant protein-D (SP-D) level was 135 ng/mL (82.2-176.7 ng/mL). High-resolution CT revealed centrilobular opacities in 23 patients (63.9%). Relapse of CEP was observed in 20 patients (55.6%). Higher serum SP-D levels and the presence of centrilobular opacities on high-resolution CT were significant predictors of relapse in multivariate Cox proportional hazard regression analysis (P=0.017 and P=0.028, respectively). Additionally, we devised a relapse prediction model for CS-treated CEP using two categorical parameters: the presence of centrilobular opacities and serum levels of SP-D (>135/≤135 ng/mL). Based on these parameters, cases were scored 2, 1, or 0. Patients with a score of 2 experienced relapses earlier than those with scores of 1 and 0 (log-rank test; P=0.006, P=0.003, respectively). CONCLUSIONS Centrilobular opacities on high-resolution CT and higher serum SP-D levels at diagnosis may be predictive factors for relapse in CS-treated patients with CEP.
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Affiliation(s)
- Naoko Takeuchi
- Department of Internal Medicine, National Hospital Organization Kinki-Chuo Chest Medical Center, Sakai City, Osaka, Japan
| | - Toru Arai
- Clinical Research Center, National Hospital Organization Kinki-Chuo Chest Medical Center, Sakai City, Osaka, Japan
| | - Yumiko Sasaki
- Department of Respiratory Medicine, Gifu Prefectural Tajimi Hospital, Tajimi City, Gifu, Japan
| | - Masanori Akira
- Department of Radiology, Katano Hospital, Katano City, Osaka, Japan
| | - Yoshinobu Matsuda
- Department of Internal Medicine, National Hospital Organization Kinki-Chuo Chest Medical Center, Sakai City, Osaka, Japan
- Clinical Research Center, National Hospital Organization Kinki-Chuo Chest Medical Center, Sakai City, Osaka, Japan
| | - Kazunobu Tachibana
- Department of Internal Medicine, National Hospital Organization Kinki-Chuo Chest Medical Center, Sakai City, Osaka, Japan
- Clinical Research Center, National Hospital Organization Kinki-Chuo Chest Medical Center, Sakai City, Osaka, Japan
| | - Takahiko Kasai
- Department of Pathology, Japanese Red Cross Tokushima Hospital, Komatsushima City, Tokushima, Japan
| | - Yoshikazu Inoue
- Clinical Research Center, National Hospital Organization Kinki-Chuo Chest Medical Center, Sakai City, Osaka, Japan
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Acute Eosinophilic Pneumonia after Combined Use of Conventional and Heat-Not-Burn Cigarettes: A Case Report. Medicina (B Aires) 2022; 58:medicina58111527. [DOI: 10.3390/medicina58111527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 10/21/2022] [Accepted: 10/23/2022] [Indexed: 11/06/2022] Open
Abstract
Background: Acute eosinophilic pneumonia (AEP) is a rare acute respiratory disease accompanied by fever, shortness of breath, and cough. Although the pathogenesis of the disease is not yet established, the patient’s condition improves with a rapid therapeutic response to systemic corticosteroids. Conventional cigarettes or heat-not-burn cigarettes are the most common cause of AEP among young people. Case Presentation: A 22-year-old woman with dyspnea, cough, and fever did not improve after visiting the local medical center and was admitted to the emergency room. The patient denied having any recent travel history or insect bites. She was treated with appropriate antibiotics according to the community acquired pneumonia, but there was no improvement. Chest radiography showed bilateral patches of pulmonary infiltration, and chest computed tomography revealed bilateral multifocal patchy consolidations with multiple small nodular ground-glass opacities and interlobular septal thickening. The bronchoalveolar lavage result was dominantly eosinophilic. The patient’s condition improved rapidly after the use of intravenous methylprednisolone and then a change to oral methylprednisolone. Finally, the patient was hospitalized for 9 days, and the duration of use of methylprednisolone including outpatient visits was 14 days. Results: The early treatment of AEP yields a good prognosis, but since the symptoms of AEP are similar to those of infectious diseases such as community-acquired pneumonia, physicians should be meticulous in differentiating AEP from other diseases. Conclusions: Since AEP shows a good response to steroids, early detection using an appropriate diagnostic method is recommended. In addition, there should be strong education against smoking in any form.
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Data mining for adverse drug reaction signals of daptomycin based on real-world data: a disproportionality analysis of the US Food and Drug Administration adverse event reporting system. Int J Clin Pharm 2022; 44:1351-1360. [PMID: 36178607 DOI: 10.1007/s11096-022-01472-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 08/12/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Previous reports on daptomycin's adverse drug reactions (ADRs) have been insufficient, often because of limited data. Pharmacovigilance risk signal detection is innovative and has been applied to the safety monitoring and reevaluation of drugs post-marketing. AIM The study aimed to promote safe daptomycin prescribing by mining and evaluating the daptomycin ADR signals from the US Food and Drug Administration Adverse Event Reporting System (FAERS). METHOD A disproportionality analysis (reporting odds ratio ROR and proportional reporting ratio PRR) was utilized for FAERS data mining from the first quarter of 2004 to the second quarter of 2021 (the most recent quarterly data at the time of the study). Preferred Terms of ADR reports were categorized by System Organ Class (SOC) based on the Medical Dictionary for Regulatory Activities. RESULTS This study retrieved 12,221 cases within the reporting period. A total of 140 repetitive signals were obtained by ROR and PRR, of which 53 new ADR signals were not recorded in the drug labels/datasheets. The top three ADR reports were "blood creatine phosphokinase elevation" (ROR, 56.66, 95% confidence interval (CI) 51.07-62.87, PRR 51.94), "eosinophilic pneumonia" (ROR 696.71, 95%CI 603.21-804.70, PRR 657.57), and "rhabdomyolysis" (ROR 22.85, 95%CI 19.94-26.18, PRR 21.83). The highest ROR of "antimicrobial susceptibility test resistant" was found at 9808.14. Reports of rare adverse events, such as "necrotizing fasciitis and compartment syndrome," have emerged. The significant SOCs were "Infections and Infestations" and "Investigations." CONCLUSION New daptomycin ADR signals were detected. Clinicians should monitor these potential ADRs in patients receiving daptomycin.
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Zhu M, Yang J, Chen Y. Efficacy and safety of treatment with benralizumab for eosinophilic asthma. Int Immunopharmacol 2022; 111:109131. [PMID: 35998507 DOI: 10.1016/j.intimp.2022.109131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 07/26/2022] [Accepted: 08/03/2022] [Indexed: 12/01/2022]
Abstract
Eosinophilic asthma accounts for 40% to 50% of asthmatic patients. However, 5% to 10% of patients with asthma need high-dose drug control, which is clinically referred to as severe asthma patients. Interleukin (IL)-5 plays an important role in the proliferation, maturation, and migration of eosinophils. Benralizumab, as an antagonist of the IL-5 receptor, can treat eosinophilic asthma by promoting the apoptosis of eosinophils. The implications for efficacy and/or adverse events are unclear. This article reviews the findings about benralizumab in the treatment of severe eosinophilic asthma in recent years. Results indicated the effectiveness of benralizumab for the treatment of severe asthma.
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Affiliation(s)
- Miaojuan Zhu
- Department of Respiratory and Critical Care Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China.
| | - Jiong Yang
- Department of Respiratory and Critical Care Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China.
| | - Yifei Chen
- Department of Respiratory and Critical Care Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China.
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Amratia DA, Viola H, Ioachimescu OC. Glucocorticoid therapy in respiratory illness: bench to bedside. J Investig Med 2022; 70:1662-1680. [PMID: 35764344 DOI: 10.1136/jim-2021-002161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2022] [Indexed: 11/07/2022]
Abstract
Each year, hundreds of millions of individuals are affected by respiratory disease leading to approximately 4 million deaths. Most respiratory pathologies involve substantially dysregulated immune processes that either fail to resolve the underlying process or actively exacerbate the disease. Therefore, clinicians have long considered immune-modulating corticosteroids (CSs), particularly glucocorticoids (GCs), as a critical tool for management of a wide spectrum of respiratory conditions. However, the complex interplay between effectiveness, risks and side effects can lead to different results, depending on the disease in consideration. In this comprehensive review, we present a summary of the bench and the bedside evidence regarding GC treatment in a spectrum of respiratory illnesses. We first describe here the experimental evidence of GC effects in the distal airways and/or parenchyma, both in vitro and in disease-specific animal studies, then we evaluate the recent clinical evidence regarding GC treatment in over 20 respiratory pathologies. Overall, CS remain a critical tool in the management of respiratory illness, but their benefits are dependent on the underlying pathology and should be weighed against patient-specific risks.
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Izhakian S, Pertzov B, Rosengarten D, Kramer MR. Successful treatment of acute relapse of chronic eosinophilic pneumonia with benralizumab and without corticosteroids: A case report. World J Clin Cases 2022; 10:6105-6109. [PMID: 35949821 PMCID: PMC9254203 DOI: 10.12998/wjcc.v10.i18.6105] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 11/05/2021] [Accepted: 05/07/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Currently, the mainstay of chronic eosinophilic pneumonia (CEP) treatment is corticosteroids, usually with a favorable response and good prognosis. However, relapse is common, requiring long-term use of corticosteroids, with risk of significant treatment-related complications. The dire need to develop new treatments for patients with CEP, who are dependent on, or resistant to corticosteroids has led to exploring novel therapies. We herein describe a patient with acute relapse of CEP, who was successfully treated with benralizumab, an IL-5Rα antagonist that has demonstrated rapid anti-eosinophil action in patients with asthma. Currently, only three recent patient reports on CEP relapse, also demonstrated successful treatment with benralizumab alone, without corticosteroids.
CASE SUMMARY A 31-year-old non-smoking woman presented in our hospital with a 3 wk history of shortness of breath, dry cough and fever up to 38.3 °C. Laboratory examination revealed leukocytosis 10240 K/µL, eosinophilia 900 K/µL and normal values of hemoglobin, platelets, creatinine and liver enzymes. Computed tomography of the chest showed a mediastinal lymphadenopathy and consolidations in the right upper and left lower lobes. CEP was diagnosed, and the patient was treated with hydrocortisone intravenously, followed by oral prednisone, with prompt improvement. Three months later, she presented with relapse of CEP: aggravation of dyspnea, rising of eosinophilia and extension of pulmonary infiltrates on chest X-ray. She was treated with benralizumab only, with clinical improvement within 2 wk, and complete resolution of lung infiltrates following 5 wk.
CONCLUSION Due to Benralizumab’s dual mechanism of action, it both neutralizes IL-5Rα pro-eosinophil functions and triggers apoptosis of eosinophils. We therefore maintain benralizumab can serve as a reasonable therapy choice for every patient with chronic eosinophilic pneumonia and a good alternative for corticosteroids.
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Affiliation(s)
- Shimon Izhakian
- Pulmonary Institute, Rabin Medical Center, Petach Tikva 49100, Israel
- Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel
| | - Barak Pertzov
- Pulmonary Institute, Rabin Medical Center, Petach Tikva 49100, Israel
- Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel
| | - Dror Rosengarten
- Pulmonary Institute, Rabin Medical Center, Petach Tikva 49100, Israel
- Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel
| | - Mordechai R Kramer
- Pulmonary Institute, Rabin Medical Center, Petach Tikva 49100, Israel
- Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel
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39
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Jankowska E, Bartoszuk I, Lewandowska K, Dybowska M, Opoka L, Tomkowski W, Szturmowicz M. Acute Eosinophilic Pneumonia Complicated with Venous Thromboembolic Disease—Diagnostic and Therapeutic Considerations. Diagnostics (Basel) 2022; 12:diagnostics12061425. [PMID: 35741235 PMCID: PMC9221981 DOI: 10.3390/diagnostics12061425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 06/02/2022] [Accepted: 06/07/2022] [Indexed: 11/16/2022] Open
Abstract
Acute Eosinophilic Pneumonia (AEP) is a rare idiopathic disease caused by an accumulation of eosinophils in the pulmonary alveoli and interstitial tissue of the lungs. The onset of symptoms is acute; some patients develop respiratory failure. The diagnosis is based on clinical symptoms, diffuse interstitial infiltrates in the lungs on imaging studies, and eosinophilia exceeding 25% on bronchoalveolar lavage or pleural fluid smear. Smokers are primarily at increased risk for the disease. We present a case of venous thromboembolic disease (VTE) that developed in the course of AEP in a previously healthy male smoker. Complete remission of the disease was achieved with anticoagulation therapy combined with a low dose of steroids. Surprisingly, further diagnostics revealed the presence of thrombophilia: antithrombin (AT) deficiency and increased homocysteine level. According to our knowledge, this is the first case of VTE diagnosed in the course of AEP combined with thrombophilia.
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Affiliation(s)
- Ewa Jankowska
- 1st Department of Lung Diseases, National Research Institute of Tuberculosis and Lung Diseases, 01-138 Warsaw, Poland; (E.J.); (I.B.); (M.D.); (W.T.); (M.S.)
| | - Iwona Bartoszuk
- 1st Department of Lung Diseases, National Research Institute of Tuberculosis and Lung Diseases, 01-138 Warsaw, Poland; (E.J.); (I.B.); (M.D.); (W.T.); (M.S.)
| | - Katarzyna Lewandowska
- 1st Department of Lung Diseases, National Research Institute of Tuberculosis and Lung Diseases, 01-138 Warsaw, Poland; (E.J.); (I.B.); (M.D.); (W.T.); (M.S.)
- Correspondence: ; Tel.: +48-692-682-078
| | - Małgorzata Dybowska
- 1st Department of Lung Diseases, National Research Institute of Tuberculosis and Lung Diseases, 01-138 Warsaw, Poland; (E.J.); (I.B.); (M.D.); (W.T.); (M.S.)
| | - Lucyna Opoka
- Department of Radiology, National Research Institute of Tuberculosis and Lung Diseases, 01-138 Warsaw, Poland;
| | - Witold Tomkowski
- 1st Department of Lung Diseases, National Research Institute of Tuberculosis and Lung Diseases, 01-138 Warsaw, Poland; (E.J.); (I.B.); (M.D.); (W.T.); (M.S.)
| | - Monika Szturmowicz
- 1st Department of Lung Diseases, National Research Institute of Tuberculosis and Lung Diseases, 01-138 Warsaw, Poland; (E.J.); (I.B.); (M.D.); (W.T.); (M.S.)
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Jackson DJ, Akuthota P, Andradas R, Bredenoord AJ, Cordell A, Gray S, Kullman J, Mathur SK, Pavord I, Roufosse F, Rubio C, Rusek IC, Simon D, Strobel MJ, Winders T. Improving Care in Eosinophil-Associated Diseases: A Charter. Adv Ther 2022; 39:2323-2341. [PMID: 35489014 PMCID: PMC9055373 DOI: 10.1007/s12325-022-02110-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 03/02/2022] [Indexed: 11/11/2022]
Abstract
Eosinophil-associated diseases (EADs) are a range of heterogeneous conditions in which eosinophils are believed to play a critical pathological role. EADs include common illnesses such as eosinophilic asthma and chronic rhinosinusitis and rare conditions such as hypereosinophilic syndromes (HES) and eosinophilic gastrointestinal disorders (EGIDs). EADs are associated with substantial burdens for the patient, including chronic, debilitating symptoms, increased financial burden, decreased health-related quality of life, and the need for repeated visits to multiple different healthcare professionals (HCPs), emergency departments, and/or hospitals. Poor EAD recognition by HCPs often contributes to delayed diagnoses, which further delays patient access to appropriate care and effective treatments, contributing to poor health outcomes. The objective of this charter is to outline key patient rights and expectations with respect to the management of their condition(s) and to set forth an ambitious action plan to improve health outcomes for patients with EADs: (1) people with EADs, their caretakers, HCPs, and the public must have greater awareness and education about EADs; (2) people with EADs must receive a timely, accurate diagnosis; (3) all people with EADs must have access to an appropriate multidisciplinary team, when necessary; and (4) people with EADs must have access to safe and effective treatment options without unnecessary regulatory delays. The principles described in this charter demonstrate the core elements of quality care that people with EADs must receive, and they represent clear steps by which to reduce patient and caregiver burden and improve patient outcomes. We urge HCPs, healthcare systems, and policymakers worldwide to swiftly adopt these principles to ensure patients with EADs have an accurate diagnosis in a timely manner and access to high-level care and treatment in an appropriate setting.
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Kodama T, Watanabe T, Mataki N, Kanoh S, Kichikawa Y. Acute eosinophilic pneumonia following aromatherapy with essential oil. Respir Med Case Rep 2022; 37:101657. [PMID: 35573977 PMCID: PMC9092961 DOI: 10.1016/j.rmcr.2022.101657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 04/13/2022] [Accepted: 04/20/2022] [Indexed: 11/28/2022] Open
Abstract
Essential oils are liquid extracts of various plants with potential health benefits and are often used in aromatherapy. Contact allergy, including skin irritation, is a well-known side effects of these extracts. A Japanese woman visited our emergency department complaining of dyspnea, cough, and fever. Two weeks earlier, she had started aromatherapy using a humidifier and essential oil. Based on clinical and imaging findings, and the results of bronchoalveolar lavage, we diagnosed acute eosinophilic pneumonia due to inhalation of essential oil. Her symptoms resolved after steroid therapy. This case makes the clinicians aware the possibility of acute eosinophilic pneumonia induced by aromatherapy using essential oil.
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Affiliation(s)
- Tatsuya Kodama
- Department of Pulmonary Medicine, Mishuku Hospital, 5-35-12 Kamimeguro, Meguro, Tokyo, 153-0051, Japan
- Corresponding author. 5-33-12 Kamimeguro, Meguro, Tokyo, 153-0051, Japan.
| | - Takanori Watanabe
- Department of Pathology, Self-Defense Forces Central Hospital, 1-2-24 Ikejiri, Setagaya, Tokyo, 154-8532, Japan
| | - Norikazu Mataki
- Department of General Internal Medicine, Mishuku Hospital, 5-35-12 Kamimeguro, Meguro, Tokyo, 153-0051, Japan
| | - Soichiro Kanoh
- Department of Pulmonary Medicine, Mishuku Hospital, 5-35-12 Kamimeguro, Meguro, Tokyo, 153-0051, Japan
| | - Yoshiko Kichikawa
- Department of Pulmonary Medicine, Mishuku Hospital, 5-35-12 Kamimeguro, Meguro, Tokyo, 153-0051, Japan
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42
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Hanaoka Y, Kiyohara E, Tani M, Kusakabe S, Maeda T, Tanemura A, Fujimoto M. A rare case of folliculotropic mycosis fungoides with eosinophilic pneumonia. JOURNAL OF CUTANEOUS IMMUNOLOGY AND ALLERGY 2022. [DOI: 10.1002/cia2.12229] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Yuma Hanaoka
- Department of Dermatology Graduate School of Medicine Osaka University Suita Japan
| | - Eiji Kiyohara
- Department of Dermatology Graduate School of Medicine Osaka University Suita Japan
| | - Mamori Tani
- Department of Dermatology Graduate School of Medicine Osaka University Suita Japan
| | - Shinsuke Kusakabe
- Department of Hematology and Oncology Graduate School of Medicine Osaka University Suita Japan
| | - Tetsuo Maeda
- Department of Hematology and Oncology Graduate School of Medicine Osaka University Suita Japan
| | - Atsushi Tanemura
- Department of Dermatology Graduate School of Medicine Osaka University Suita Japan
| | - Manabu Fujimoto
- Department of Dermatology Graduate School of Medicine Osaka University Suita Japan
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43
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Tashiro H, Takahashi K, Kurihara Y, Sadamatsu H, Kuwahara Y, Kimura S, Sueoka-Aragane N. Anti-IL-5 Agents for the Treatment of Idiopathic Chronic Eosinophilic Pneumonia: A Case Series. J Asthma Allergy 2022; 15:169-177. [PMID: 35177908 PMCID: PMC8843786 DOI: 10.2147/jaa.s343272] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 01/11/2022] [Indexed: 12/11/2022] Open
Abstract
Purpose Idiopathic chronic eosinophilic pneumonia (ICEP) is a rare, chronic respiratory disease. Corticosteroid therapy is effective for ICEP, but relapse is frequent after its tapering, which leads to chronic use and corticosteroid-related adverse effects. Currently, biological agents targeting interleukin 5 (IL-5) are considered alternatives for treating ICEP patients with frequent relapse, but the detailed effects are not fully understood. Patients and Methods The clinical characteristics of 30 patients with ICEP, especially 12 patients with ICEP who experienced relapse after corticosteroid dose tapering, were evaluated retrospectively. In addition, 4 ICEP patients with frequent relapse treated by IL-5-targeted biological agents were reviewed. Results Of the 30 patients diagnosed with ICEP, 12 patients (40.0%) recurred after corticosteroid dose tapering, and 9 (30.0%) were treated with maintenance doses of corticosteroid. Of ICEP patients who experienced recurrence, 6 (50.0%) had frequent relapses (2 or more times). All 4 patients treated with anti-IL-5 agents had their corticosteroid dose reduced without any relapses; in 3 patients, corticosteroids were withdrawn. Conclusion Anti-IL-5 agents might be alternatives for treating ICEP patients with frequent relapses.
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Affiliation(s)
- Hiroki Tashiro
- Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, Japan
- Correspondence: Hiroki Tashiro, Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, Saga Prefecture, 849-8501, Japan, Tel +81-952-34-2369, Fax +81-952-34-2017, Email
| | - Koichiro Takahashi
- Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, Japan
| | - Yuki Kurihara
- Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, Japan
| | - Hironori Sadamatsu
- Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, Japan
| | - Yuki Kuwahara
- Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, Japan
| | - Shinya Kimura
- Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, Japan
| | - Naoko Sueoka-Aragane
- Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, Japan
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Kawabata H, Satoh M, Yatera K. Development of Rheumatoid Arthritis During Anti-Interleukin-5 Therapy in a Patient with Refractory Chronic Eosinophilic Pneumonia. J Asthma Allergy 2021; 14:1425-1430. [PMID: 34858033 PMCID: PMC8631983 DOI: 10.2147/jaa.s342993] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 11/16/2021] [Indexed: 01/01/2023] Open
Abstract
Purpose To report the case of a patient with refractory chronic eosinophilic pneumonia who developed rheumatoid arthritis during anti-interleukin (IL)-5 therapy. Case Report The case of a 66-year-old male ex-smoker with allergic rhinitis who had dyspnea and chronic cough for 6 months and who was ultimately diagnosed with chronic eosinophilic pneumonia is reported. Long-term corticosteroid therapy was necessary due to recurrence of the chronic eosinophilic pneumonia during tapering of the corticosteroid. As a steroid sparing strategy, mepolizumab was initiated, and the steroid was tapered gradually. When the dose of prednisolone was 2 mg/day, he developed polyarthralgia. Mepolizumab was changed to benralizumab considering the possibility that arthralgia was a side effect of mepolizumab; however, the arthralgia continued and he was ultimately diagnosed with rheumatoid arthritis. Methotrexate was initiated and his arthritis improved. Thereafter, benralizumab was discontinued after 5 injections, and he subsequently required neither systemic corticosteroids nor biologics. Conclusion The present case may suggest that suppression of IL-5 induces rheumatoid arthritis in certain patients; however, it is also possible that initial steroid therapy improved subclinical RA and made it remain undiagnosed, and the parallel OCS tapering during IL-5 therapy could have contributed to unveil the underlying RA. Further studies are required to establish guidelines on the optimum use of anti-IL-5 therapy and to understand the interactions between chronic eosinophilic pneumonia, anti-IL-5 therapy, tapering of corticosteroid and development of rheumatoid arthritis.
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Affiliation(s)
- Hiroki Kawabata
- Department of Respiratory Medicine, University of Occupational and Environmental Health, Kitakyushu, Fukuoka, 807-8555, Japan
| | - Minoru Satoh
- Department of Clinical Nursing, University of Occupational and Environmental Health, Kitakyushu, Fukuoka, 807-8555, Japan
| | - Kazuhiro Yatera
- Department of Respiratory Medicine, University of Occupational and Environmental Health, Kitakyushu, Fukuoka, 807-8555, Japan
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Miki M, Ohara Y, Tsujino K, Kawasaki T, Kuge T, Yamamoto Y, Matsuki T, Miki K, Kida H. Pulmonary eosinophilia may indicate onset stage of allergic bronchopulmonary aspergillosis. ALLERGY, ASTHMA, AND CLINICAL IMMUNOLOGY : OFFICIAL JOURNAL OF THE CANADIAN SOCIETY OF ALLERGY AND CLINICAL IMMUNOLOGY 2021; 17:118. [PMID: 34794492 PMCID: PMC8600892 DOI: 10.1186/s13223-021-00624-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 11/06/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Allergic bronchopulmonary aspergillosis (ABPA) and chronic eosinophilic pneumonia (CEP) both display peripheral eosinophilia as well as pulmonary infiltration, together described as pulmonary eosinophilia, and differentiation is sometimes problematic. This study therefore examined the distinctions between ABPA with and without CEP-like shadows. METHODS This retrospective cohort study from a single center included 25 outpatients (median age, 65 years) with ABPA diagnosed between April 2015 and March 2019, using criteria proposed by the International Society of Human and Animal Mycology (ISHAM), which focuses on positive specific IgE for Aspergillus fumigatus. Patients were assigned to either the eosinophilic pneumonia (EP) group or Non-EP group, defined according to findings on high-resolution computed tomography (HRCT). The EP group included patients with HRCT findings compatible with CEP; i.e., the presence of peripheral consolidation (p-consolidation) or ground-glass opacities (GGO), with no evidence of high-attenuation mucus. The Non-EP group comprised the remaining patients, who showed classical findings of ABPA such as mucoid impaction. Differences between the groups were analyzed. RESULTS Baseline characteristics, frequency of a history of CEP (EP, 50% vs. Non-EP, 26%) and tentative diagnosis of CEP before diagnosis of ABPA (67% vs. 16%) did not differ significantly between groups. Although elevated absolute eosinophil count and Aspergillus-specific immunoglobulin E titers did not differ significantly between groups, the Non-EP group showed a strong positive correlation between these values (R = 0.7878, p = 0.0003). The Non-EP group displayed significantly higher levels of the fungal marker beta-D glucan (median, 11.7 pg/ml; interquartile range, 6.7-18.4 pg/ml) than the EP group (median, 6.6 pg/ml; interquartile range, 5.2-9.3 pg/ml). Both groups exhibited frequent recurrence of shadows on X-rays but no cases in the EP group had progressed to the Non-EP group at the time of relapse. CONCLUSIONS The ABPA subgroup with imaging findings resembling CEP experienced frequent recurrences, as in typical ABPA. In pulmonary eosinophilia, even if there are no shadows indicating apparent mucous change, the Aspergillus-specific immunoglobulin E level is important in obtaining an accurate diagnosis and in the selection of appropriate therapies for this type of ABPA.
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Affiliation(s)
- Mari Miki
- Department of Respiratory Medicine, National Hospital Organization Osaka Toneyama Medical Center, Osaka, Japan. .,Department of Internal Medicine, Tokushima Prefecture Naruto Hospital, 32 Kotani, Kurosaki, Muya-cho, Naruto, Tokushima, 772-8503, Japan.
| | - Yuko Ohara
- Department of Respiratory Medicine, National Hospital Organization Osaka Toneyama Medical Center, Osaka, Japan.,Department of Respiratory Medicine, Ikuwakai Memorial Hospital, Osaka, Japan
| | - Kazuyuki Tsujino
- Department of Respiratory Medicine, National Hospital Organization Osaka Toneyama Medical Center, Osaka, Japan
| | - Takahiro Kawasaki
- Department of Respiratory Medicine, National Hospital Organization Osaka Toneyama Medical Center, Osaka, Japan
| | - Tomoki Kuge
- Department of Respiratory Medicine, National Hospital Organization Osaka Toneyama Medical Center, Osaka, Japan
| | - Yuji Yamamoto
- Department of Respiratory Medicine, National Hospital Organization Osaka Toneyama Medical Center, Osaka, Japan
| | - Takanori Matsuki
- Department of Respiratory Medicine, National Hospital Organization Osaka Toneyama Medical Center, Osaka, Japan
| | - Keisuke Miki
- Department of Respiratory Medicine, National Hospital Organization Osaka Toneyama Medical Center, Osaka, Japan
| | - Hiroshi Kida
- Department of Respiratory Medicine, National Hospital Organization Osaka Toneyama Medical Center, Osaka, Japan
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Araújo M, Correia S, Lima AL, Costa M, Neves I. SARS-CoV-2 as a trigger of eosinophilic pneumonia. Pulmonology 2021; 28:62-64. [PMID: 34470721 PMCID: PMC8326004 DOI: 10.1016/j.pulmoe.2021.07.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 07/19/2021] [Accepted: 07/19/2021] [Indexed: 11/25/2022] Open
Affiliation(s)
- M Araújo
- Pulmonology Department, Hospital Pedro Hispano, 4464-513 Senhora da Hora, Portugal.
| | - S Correia
- Pulmonology Department, Hospital Pedro Hispano, 4464-513 Senhora da Hora, Portugal
| | - A L Lima
- Department of Internal Medicine, Hospital Pedro Hispano, Portugal
| | - M Costa
- Department of Medical Oncology, Hospital Pedro Hispano, Portugal
| | - I Neves
- Pulmonology Department, Hospital Pedro Hispano, 4464-513 Senhora da Hora, Portugal
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Ben-David Y, Bentur L, Gur M, Ilivitzki A, Gut G, Toukan Y, Nir V, Shallufi G, Bar-Yoseph R. Reverse butterfly pattern image with eosinophilia: Effective treatment with benralizumab-A case report. Pediatr Pulmonol 2021; 56:2736-2739. [PMID: 34077999 DOI: 10.1002/ppul.25511] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 05/07/2021] [Accepted: 05/07/2021] [Indexed: 11/07/2022]
Abstract
A 16-year-old adolescent presented with dry cough, fever, weight loss, night sweats, exercise intolerance, and eosinophilia. Computed tomography showed consolidations with "reverse butterfly" pattern. He responded well to corticosteroids but had frequent relapses. He became steroid dependent and developed steroid related morbidity. Benralizumab was prescribed with complete resolution of eosinophilia and lung infiltrates with no adverse effect.
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Affiliation(s)
- Yael Ben-David
- Pediatric Pulmonary Institute, Ruth Children's Hospital, Rambam Health Care Campus, Haifa, Israel
| | - Lea Bentur
- Pediatric Pulmonary Institute, Ruth Children's Hospital, Rambam Health Care Campus, Haifa, Israel.,Faculty of Medicine, Technion, Haifa, Israel
| | - Michal Gur
- Pediatric Pulmonary Institute, Ruth Children's Hospital, Rambam Health Care Campus, Haifa, Israel.,Faculty of Medicine, Technion, Haifa, Israel
| | - Anat Ilivitzki
- Pediatric Imaging Unit, Ruth Children's Hospital, Rambam Health Care Campus, Haifa, Israel
| | - Guy Gut
- Pediatric Pulmonary Institute, Ruth Children's Hospital, Rambam Health Care Campus, Haifa, Israel
| | - Yazeed Toukan
- Pediatric Pulmonary Institute, Ruth Children's Hospital, Rambam Health Care Campus, Haifa, Israel.,Faculty of Medicine, Technion, Haifa, Israel
| | - Vered Nir
- Pediatric Pulmonary Institute, Ruth Children's Hospital, Rambam Health Care Campus, Haifa, Israel.,Faculty of Medicine, Technion, Haifa, Israel
| | - George Shallufi
- Pediatric Pulmonary Institute, Ruth Children's Hospital, Rambam Health Care Campus, Haifa, Israel
| | - Ronen Bar-Yoseph
- Pediatric Pulmonary Institute, Ruth Children's Hospital, Rambam Health Care Campus, Haifa, Israel.,Faculty of Medicine, Technion, Haifa, Israel
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Miyabe Y, Kobayashi Y, Fukuchi M, Saga A, Moritoki Y, Saga T, Akuthota P, Ueki S. Eosinophil-mediated inflammation in the absence of eosinophilia. Asia Pac Allergy 2021; 11:e30. [PMID: 34386406 PMCID: PMC8331253 DOI: 10.5415/apallergy.2021.11.e30] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 07/10/2021] [Indexed: 12/14/2022] Open
Abstract
The increase of eosinophil levels is a hallmark of type-2 inflammation. Blood eosinophil counts act as a convenient biomarker for asthma phenotyping and the selection of biologics, and they are even used as a prognostic factor for severe coronavirus disease 2019. However, the circulating eosinophil count does not always reflect tissue eosinophilia and vice versa. The mismatch of blood and tissue eosinophilia can be seen in various clinical settings. For example, blood eosinophil levels in patients with acute eosinophilic pneumonia are often within normal range despite the marked symptoms and increased number of eosinophils in bronchoalveolar lavage fluid. Histological studies using immunostaining for eosinophil granule proteins have revealed the extracellular deposition of granule proteins coincident with pathological conditions, even in the absence of a significant eosinophil infiltrate. The marked deposition of eosinophil granule proteins in tissue is often associated with cytolytic degranulation. Recent studies have indicated that extracellular trap cell death (ETosis) is a major mechanism of cytolysis. Cytolytic ETosis is a total cell degranulation in which cytoplasmic and nuclear contents, including DNA and histones that act as alarmins, are also released. In the present review, eosinophil-mediated inflammation in such mismatch conditions is discussed.
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Affiliation(s)
- Yui Miyabe
- Department of General Internal Medicine and Clinical Laboratory Medicine, Akita University Graduate School of Medicine, Akita, Japan
| | - Yoshiki Kobayashi
- Airway Disease Section, Department of Otorhinolaryngology, Kansai Medical University, Hirakata, Japan.,Allergy Center, Kansai Medical University, Hirakata, Japan
| | - Mineyo Fukuchi
- Department of General Internal Medicine and Clinical Laboratory Medicine, Akita University Graduate School of Medicine, Akita, Japan
| | - Akiko Saga
- Department of General Internal Medicine and Clinical Laboratory Medicine, Akita University Graduate School of Medicine, Akita, Japan
| | - Yuki Moritoki
- Department of General Internal Medicine and Clinical Laboratory Medicine, Akita University Graduate School of Medicine, Akita, Japan
| | - Tomoo Saga
- Department of General Internal Medicine and Clinical Laboratory Medicine, Akita University Graduate School of Medicine, Akita, Japan
| | - Praveen Akuthota
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Shigeharu Ueki
- Department of General Internal Medicine and Clinical Laboratory Medicine, Akita University Graduate School of Medicine, Akita, Japan
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Takeda M, Sakamoto S, Ueki S, Miyabe Y, Fukuchi M, Okuda Y, Asano M, Sato K, Nakayama K. Eosinophil extracellular traps in a patient with chronic eosinophilic pneumonia. Asia Pac Allergy 2021; 11:e24. [PMID: 34386400 PMCID: PMC8331252 DOI: 10.5415/apallergy.2021.11.e24] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 07/06/2021] [Indexed: 01/03/2023] Open
Abstract
Eosinophils rapidly release extracellular filamentous chromatin fibers (extracellular traps, ETs) when they are stimulated. Reticulated ETs have been recently shown to affect secretion viscosity in eosinophilic inflammatory diseases. Here we report a 43-year-old woman with infiltrative shadows in both upper lungs that did not respond well to antibiotics. She admitted to occasional coughing and sputum, but had poor viscous regulation. Bronchoalveolar lavage fluid (BALF) collected from the upper left lobe showed many eosinophils (65%). She was diagnosed with chronic eosinophilic pneumonia, per previously reported criteria, and began treatment with prednisolone. The infiltration shadow gradually improved, and she was discharged 28 days after admission. Later, we immune-stained her BALF cell components with antibodies against major basic protein, an eosinophil granule protein, which showed a large number of agglomerating eosinophils; and antibodies against citrullinated histone H3 (CitH3-a marker for ETs), which showed CitH3-positive ETs, spread in a network. These findings confirmed that some BALF eosinophils released eosinophil ETs. This case shows the existence of ETs from BALF in patients with chronic eosinophilic pneumonia. Concentration of eosinophil ETs in eosinophilic inflammatory diseases may affect secretion viscosity in sputum, and so on.
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Affiliation(s)
- Masahide Takeda
- Department of Respiratory Medicine, Akita University Graduate School of Medicine, Akita, Japan
| | - Sho Sakamoto
- Department of Respiratory Medicine, Akita University Graduate School of Medicine, Akita, Japan
| | - Shigeharu Ueki
- Department of General Internal Medicine and Clinical Laboratory Medicine, Akita University Graduate School of Medicine, Akita, Japan
| | - Yui Miyabe
- Department of General Internal Medicine and Clinical Laboratory Medicine, Akita University Graduate School of Medicine, Akita, Japan
| | - Mineyo Fukuchi
- Department of General Internal Medicine and Clinical Laboratory Medicine, Akita University Graduate School of Medicine, Akita, Japan
| | - Yuji Okuda
- Department of Respiratory Medicine, Akita University Graduate School of Medicine, Akita, Japan
| | - Mariko Asano
- Department of Respiratory Medicine, Akita University Graduate School of Medicine, Akita, Japan
| | - Kazuhiro Sato
- Department of Respiratory Medicine, Akita University Graduate School of Medicine, Akita, Japan
| | - Katsutoshi Nakayama
- Department of Respiratory Medicine, Akita University Graduate School of Medicine, Akita, Japan
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Carlicchi E, Gemma P, Poerio A, Caminati A, Vanzulli A, Zompatori M. Chest-CT mimics of COVID-19 pneumonia-a review article. Emerg Radiol 2021; 28:507-518. [PMID: 33646498 PMCID: PMC7917172 DOI: 10.1007/s10140-021-01919-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 02/15/2021] [Indexed: 01/02/2023]
Abstract
Coronavirus disease 2019 (COVID-19) emerged in early December 2019 in China, as an acute lower respiratory tract infection and spread rapidly worldwide being declared a pandemic in March 2020. Chest-computed tomography (CT) has been utilized in different clinical settings of COVID-19 patients; however, COVID-19 imaging appearance is highly variable and nonspecific. Indeed, many pulmonary infections and non-infectious diseases can show similar CT findings and mimic COVID-19 pneumonia. In this review, we discuss clinical conditions that share a similar imaging appearance with COVID-19 pneumonia, in order to identify imaging and clinical characteristics useful in the differential diagnosis.
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Affiliation(s)
- Eleonora Carlicchi
- Post-graduate School in Radiodiagnostic, Università degli Studi di Milano, Milan, Italy.
| | - Pietro Gemma
- Post-graduate School in Radiodiagnostic, Università degli Studi di Milano, Milan, Italy
| | - Antonio Poerio
- Radiology Unit, Santa Maria della Scaletta Hospital, Imola, Italy
| | - Antonella Caminati
- Respiratory Medicine and Semi-Intensive Therapy Unit, Respiratory Physiopathology and Pulmonary Haemodynamics Services, San Giuseppe Hospital Multimedica, Milan, Italy
| | - Angelo Vanzulli
- Radiology Unit, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162, Milan, Italy
- Oncology and Hemato-Oncology Unit, Università degli Studi di Milano, via Festa del Perdono 7, 20122, Milan, Italy
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