We report the case of a 72-year-old male, non-smoker, evaluated in the emergency room for 15 days of dry cough, fever and moderate dyspnea.
With no history of asthma or allergic rinitis, she also reported no use of medications; family denies use of nonsteroidal anti-inflammatory drugs, prior antibiotic therapy and cocaine or other drugs of abuse.
Hemodynamics and oximetry were within normal range.
Segmental examination revealed left lung base crypts, with no wheezing or other noise aggregated; no digital clubbing or other suggestive signs of lung disease; the rest of the physical examination was normal.
Chest X-ray showed focal consolidation in the left lower lobe (LII).
His admission tests showed leukocytosis of 13,200 cel/dL, erythrocyte sedimentation rate (HSV) of 65 mm, C-reactive protein of 15 (normal value < 5), normal biochemical profile.
With these findings hospitalization was decided and antibiotic therapy was initiated with ceftriaxone 2 g/day ev and levofloxacin 500 mg/day vo.
After one week of treatment, there was no clinical improvement.
Laboratory studies with blood count showed hematocrit 38%, hemoglobin 12 g/dL, MCV 89, leukocytes 12,500 cells/mm3, eosinophils 16.9%, platelets 234,000 cells/mm3, HSV 35 mm, CRP 15 (
Chest computed tomography (CT) showed greater consolidation of LII and a new consolidation in the left upper lobe (LSI), associated with ground glass opacities, as well as moderate left pleural effusion.
Flexible bronchoscopy with bronchoalveolar lavage (BAL) showed a total of 2.5 x 107 cells, with 95% eosinophils. Cultures, both in current media and mycobacteria, were negative and normal levels.
Transbronchial biopsy showed numerous eosinophil granulocytes in alveoli and interstitium, associated with a certain degree of interstitial fibrosis.
Pleural fluid analysis showed 1.2 x 103 cells, with 85% eosinophils, proteins 4.1 mg/dL, glucose 75 mg/dL, lactate dehydrogenase 232 and pH 7.37.
1.
Antinuclear antibodies (ANA), anti-DNA, anti-neutrophil cytoplasmic antibodies (ANCA), all negative, were requested within the study.
The study for human immunodeficiency virus (HIV) was negative and the presence of infection due to Aspergillus (Ascaris luoides), Trichinella, Faciola negative, Schizophrenia was detected.
Given the finding of eosinophilic pneumonia associated with the presence of fever and peripheral condensations, in the absence of infectious or secondary causes to drugs or drugs, a decrease in the diagnosis of ECN was proposed, starting treatment with corticosteroids 5 days
During follow-up, the patient presented two recurrences of respiratory symptoms, of similar characteristics, with good response to treatment with corticosteroids.
Currently, the patient is receiving 5 mg of mannitol per day of prednisone, which confirms the diagnosis of ECN.
