A 77-year-old nonsmoker woman presented with asthenia, anorexia and weight loss of 1 month duration, associated with fever, cough and dyspnea on minimal exertion.
This was a 20-year-old patient with asthma treated with beta-mimetics and inhaled corticosteroids, with baseline dyspnea on moderate exertion.
Physical examination revealed a Ta of 37.6 oC, and pulmonary auscultation revealed low intensity crackles in the middle and lower left fields.
Blood tests showed leukocytosis of 14400/μl with an eosinophil percentage of 26%, hemoglobin 14.9 g/dl, platelets 535,000/ml and ESR: 122 mm at the rest of the first hour.
He has an arterial gas, breathing room air with pH:7.40, pO2: 54.2 mmHg, pCO2: 46 mmHg, HCO3:28 MM/L and alveolar-arterial oxygen gradient of 38 mmHg.
Chest X-ray showed increased density in the left hilium, with peripheral infiltrates in the anterior and posterior segment of the left upper lobe.
Treatment was initiated with cefoxime, inhaled beta, and inhaled beta-antibiotics.
On the third day of admission, a fiberoptic bronchoscopy was performed due to suspicion of chronic eosinophilic pneumonia, and BAL could not be performed due to poor tolerance.
In the smear of bronchoaspirate (BAS) was moderate.
Corticosteroid treatment was initiated with the aim of achieving a progressive improvement in the following days and disappearance of peripheral corticosteroids within 24 hours.
Upon discharge she was referred to home with descending corticosteroids, inhaled beta-mimetics and inhaled steroids.
At one month after discharge, corticosteroids were discontinued, and the chest X-ray was normal and non-peripheral urticaria was absent.
During the first year of follow-up, the patient presented recurrence at 6 months, with the presence of 16'8% of eosinophylls in peripheral blood, fever and worsening of his baseline dyspnea.
Once the catheter was implanted, the patient showed severe obstruction to the airflow and moderate restriction with the following parameters: CV: 1280 ml (60%), Tiff: 580 ml (79%), CPT: 3470 ml (60%),
A new corticosteroid therapy was started and continued for nearly 12 months, with remission of symptoms.
