PMC3523559_01
Posteroanterior chest radiograph. (A) Normal posteroanterior chest radiograph. The examination was obtained one year before EPF started. (B) Two months later the signs and findings of the EPF were more prominent. Reticular and nodular opacities and areas of consolidation are seen. . Abbreviation: EPF, eosinophilic pulmonary fibrosis.
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His clinical situation promptly improved, but the X-ray findings persisted (the patient had a normal X-ray image before the examination) (Figure 1A and B).
Axial, high resolution CT images of the lungs in a patient with eosinophilic pulmonary fibrosis demonstrate peripheral distribution of airspace disease and patchy peripheral ground-glass opacities. . Abbreviation: CT, computed tomography.
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The high resolution computed tomography (HRCT) of the lungs revealed an eosinophilic pulmonary fibrosis pattern of airspace disease and patchy peripheral ground-glass opacities (Figure 2). The cardiopulmonary exercise test confirmed a limitation of pulmonary function (Wmax 95 W [53 W, ramp 12 W/minute]; VO2 max 1614 mL/minute [63% predicted] = 17.7 mL/minute/kg; Wmax 95 W = 43% predicted; O2 pulse demonstrated a plateau at 11.4 mL/beat [67%], VE/VO2 or VE/VCO2 under maximal workload [without any further reserve]).
Overview of the destructive inflammatory process. (A) Acute and chronic inflammatory changes with some scarring (upper right side) are shown. HE, magnification 25x. (B) Acute alveolitis; florid inflammatory changes with highly activated pneumocytes and overspill of acute inflammatory cells into the alveoli. HE, magnification 100x. (C) Interstitial eosinophilia; in areas of longstanding inflammation one can observe a high frequency of eosinophils. They are located in the interstitium without angiocentricity and do not show overspill into the alveoli. These eosinophilic infiltrates are the major clue to a drug-induced reaction. Giemsa, magnification 200x. (D) Bronchiolitis obliterans organizing pneumonia; within the alveoli one can observe fibrobastic proliferations following acute alveolitis shown in B. CAB, magnification 100x. (E) Scarring; in more advanced stage disease one finds an interstitial accumulation of newly synthesized collagen fibers (blue color) without accompanying inflammatory infiltrate. CAB, magnification 100x. (F) End stage; interstitial scar. Note there is no honeycombing. HE, magnification 40x. . Abbreviations: HE, hematoxylin eosin; CAB, Chromotrop-Anilinblue trichrome staining method.
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The biopsy revealed a very severe fibrotic disorder throughout most of the lung (end-stage lung) (Figure 3).
Posteroanterior chest radiograph. . Note: One year later, posteroanterior chest radiograph demonstrates prominent areas of ground-glass opacity and consolidation.
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One year later, in a scheduled check-up visit, his clinical condition was improved (6MWT, lung function parameters [TLC 55% predicted, FEV1 51% predicted]) (Figure 4).