Seminars in respiratory infections
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Semin Respir Infect · Sep 1988
ReviewEosinophilia in patients presenting with pulmonary infiltrates and fever.
A variety of infectious and noninfectious pulmonary disorders can present with pulmonary infiltrates with peripheral eosinophilia. Specific therapies are available for many of the pulmonary eosinophilic syndromes and failure to treat these syndromes can result in the development of irreversible lung disease. ⋯ However, the distinction between infectious and noninfectious processes can be difficult to make on clinical grounds alone. For these reasons, the evaluation of a patient presenting with this problem provides an interesting challenge to the physician.
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Pulmonary vasculitis is usually caused by one of three disorders: (1) Wegener's granulomatosis (WG); (2) Churg-Strauss syndrome (CSS), or allergic angiitis and granulomatosis; or (3) a nonspecific small vessel systemic necrotizing vasculitis (SNV), or microscopic polyarteritis. WG, the most common cause of lung vasculitis, has features of a granulomatous vasculitis of the upper airway and lung and widespread small vessel vasculitis involving the kidneys and other organs. The features of pulmonary WG overlap with those of malignancy and infectious granulomatous lung disease; accurate diagnosis generally requires open lung biopsy. ⋯ Nonspecific SNV causes diffuse alveolar hemorrhage due to pulmonary capillaritis. Concomitant segmental necrotizing glomerulonephritis is almost always present. Diagnosis is made by renal biopsy, compatible extrarenal features, exclusion of nonimmune causes of lung hemorrhage, and exclusion of WG to the extent possible.
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A wide variety of noncytotoxic drugs, including antibiotics, analgesics, narcotics, and psychotrophic and cardiovascular agents, may cause lung injury accompanied by roentgenographic infiltrates. The clinical manifestations of drug-induced lung disease are protean. ⋯ Finally, some drugs may cause insidiously progressive pulmonary infiltrates that share features with granulomatous infections. The more common drug reactions are discussed in this review, and, although the features of drug-induced lung disease are often relatively nonspecific, those features that either mimic infectious causes or may be helpful in differentiating these processes from infections are given particular emphasis.