• M Voss, M Allewelt, and H Lode.
• Pneumologische Abteilung I, Lungenklinik Heckeshorn, Berlin.
• Dtsch. Med. Wochenschr. 2004 Sep 3;129(36):1858-60.

History And Admission FindingsA 43-year-old woman (patient 1) and a 58-year-old man (patient 2) presented with fever, nocturnal perspiration, dry cough, dyspnoea and general weakness. These symptoms had been present for several months. Repeated courses of antibiotic treatment as outpatients had failed. On admission their general condition was unremarkable.InvestigationsThe differential blood count revealed marked eosinophilia of 35% and 27%, respectively, and raised infection parameters. Results of laboratory tests were unremarkable. Conventional radiological films and CT of the thorax showed infiltrates, especially in the periphery. In both patients bronchoscopy revealed moderately severe bronchitis. Broncho-alveolar lavage and the peripheral blood count showed marked eosinophilia of 61% and 54%, respectively. Biopsies did not reveal necrosis, fungal infection, parasites, granulomas or vasculitis.Diagnosis, Treatment And CourseThe described findings indicated a chronic eosinophilic pneumonia (CEP) in both patients. Treatment was initiated with high steroid dosage, namely 60 mg prednisolone equivalent daily, gradually reducing with improvement. The symptoms rapidly lessened and the radiological changes regressed after ca. 14 days. Intermittent recurrences were noted in both patients on reduction or termination, respectively, of the steroid treatment which had lasted for several months.ConclusionsCEP is an important disease to be considered in the differential diagnosis of unclear pulmonary infiltrates associated with an increased eosinophilia in both peripheral blood and the lungs. In some cases it may be necessary to continue steroid treatment over long periods, even years, to bring the pulmonary changes of CEP under control.

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