PMC2800002_01
Clinical courses and medications. These graphs illustrate clinical course including fever, rash, lung lesions, peripheral blood eosinophil count (solid line) and serum alanine transaminase (ALT, dashed line) over time. Under the X-axis, the medications used for the treatment of heart failure and systemic steroids are shown.
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F1
He developed a fever, cough, and sputum 1 week before admission (Fig. 1).
Skin lesions on admission. There were variable-sized, occasionally fused, erythematous macules and plaques covering the skin of the entire body.
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F2
On physical examination, variable-sized, fused erythematous macules and plaques covered his entire body, including the trunk and extremities; this rash developed on the day of admission (Fig. 2).
Imaging examination of the chest. (A) Simple radiographs of the chest on admission show diffuse heterogeneous increased opacities with a patchy distribution in both lungs. (B) Chest CT on admission shows multiple nodular consolidations with ground-glass density in both hemithoraxes and multiple mediastinal lymphadenopathy. (C) Simple radiographs of the chest after discontinuing the mexiletine and then treating the patient with oral prednisolone. The multiple infiltrative lesions disappeared from both lungs.
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F3
Chest radiographs showed multiple increased opacities with a patchy distribution in both lungs (Fig. 3A). Chest computed tomography (CT) on admission showed multiple nodular consolidations with ground-glass density in both hemithoraxes and multiple mediastinal lymphadenopathy (Fig. 3B). Subsequently, his temperature decreased, with resolution of the blood eosinophilia, liver dysfunction, and cutaneous and lung lesions (Fig. 3C).
Microscopic observation of the biopsy specimen. (A) The tissue of the lung lesion shows eosinophilic infiltration with histiocytes and granular pneumocytes (H&E stain, x400). (B) The epidermis shows parakeratosis, exocytosis of lymphocytes with spongiosis, and vacuolization. The dermis shows extravasated red blood cells and moderate perivascular lymphocytes and eosinophils (H&E stain, x400).
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F4
A fine needle aspiration biopsy of a lung lesion was performed and showed eosinophilic infiltration with histiocytes, and granular pneumocytes with an organizing alveolar exudate (Fig. 4A). The dermis showed extravasated red blood cells and moderate perivascular infiltration of lymphocytes and eosinophils (Fig. 4B).