A 65-year-old, non-smoker patient with no history of bronchial asthma presented to the emergency department complaining of evening fever, cough with poor sputum and progressive dyspnea for 1 month.
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He had been diagnosed with pneumonia 10 days before by his primary care physician, with the use of clarithromycin, which worsened.
At the initial examination, the patient was eupneic at rest, with no pulmonary auscultation findings and the rest of the normal examination, except for a temperature of 37.6oC.
The emergency laboratory showed a leukocytosis of 14,400 μ/l with biochemical parameters of 26.4%, normal coagulation hemoglobin SGA of 1.dL, platelets of 782,000 μ/l, CRP of 13.84 and 1 SGV.
Arterial gas, breathing room air, showed pH: 7.56, pO2: 67.9mmHg, pCO2: 23mmHg, HCO3: 20 MM/L, O2: 95% and alveo-78 oxygen gradient
Chest X-ray showed bilateral alveolar infiltrates predominantly peripheral in both upper lobes, especially the right upper lobe pericystural and segment 6.
A chest CT scan showed multiple alveolar infiltrates of peripheral distribution, bilateral, predominantly in the upper lobes, being more extensive the consolidation of the right upper lobe, posterior segment, as well as central adenopathy infiltrate in the right upper lobe with small
Treatment was initiated from the emergency department with broad-spectrum antibiotics with ceftacidime and amikacin, combining corticotherapy at a dose of 1 mg/kg of weight, since the possibility of eosinophilic pneumonia was raised.
A fibrobronchoscopy with BAL was performed 48 hours after admission. The flow cytometry showed 1400 cells/microliter with 80 % of mild eosinophils, as well as a transbronchial alveolar biopsy with microeosinophilic infiltrate.
In 24 hours the peripheral catheter was normalized, remitting fever and symptoms.
Respiratory function tests revealed 1,980 ml (84 %), FEV1: 1,330 6.9%, FVC1/FVC: 67 (87%), DLCO: 16.2 ml/min/mmHg (79 %), FEV1/FVC:
She was discharged with a dose of corticoids of 30 mg/d.
One month later there was radiographic improvement.
There were no recurrences during the 1st year of follow-up and corticosteroid therapy was discontinued 12 months after the procedure.
