PMC10413186_01
Chest X-ray showing diffuse granular shadows in both lungs.
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Chest X-ray and high-resolution computed tomography (HRCT) showed diffuse centrilobular granular shadows and bronchial wall thickening (Fig. 1, Fig. 2A).
(A) Chest computed tomography (CT) scan at first examination showing diffuse centrilobular nodules and bronchial wall thickening. (B) Pre-treatment chest CT scan after bronchoscopy showing a diffuse nodular shadow and new ground-grass opacity in the right middle and left lower lobes. (C) Two months after the initiation of treatment, chest CT scan showed that both the ground-grass opacity and nodular shadow had disappeared.
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Because lung biopsy was performed on the right lung only, we considered the newly appeared shadows to indicate that this case had progressed to eosinophilic pneumonia (Fig. 2B).
(A) Hematoxylin-and-eosin (H&E) staining showing inflammatory cell infiltration (mainly eosinophilic) in the bronchiolar region (arrow). (B) Masson trichrome staining showing reddish eosinophils, mainly in the bronchiolar region (arrow). (C) Pathology of the alveolar showing slight eosinophilic infiltration. (D) Pathology of the main bronchus showing exudation of chronic inflammatory cells without eosinophils.
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There were markedly fewer eosinophils in the alveolar region than in eosinophilic pneumonia; eosinophils were mainly concentrated in the bronchiolar region (Fig. 3A-C). In contrast, marked infiltration of eosinophils was not observed in specimens collected from the second carina, which showed exudation of chronic inflammatory cells (Fig. 3D).
Clinical course. Following therapy with an oral corticosteroid, the peripheral blood eosinophil count and levels of fractional exhaled nitric oxide (FeNO) were decreased, and the respiratory function was improved. However, these values were elevated when the dose of oral prednisone was reduced to 2.5 mg.
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After treatment, the respiratory function was markedly improved (Fig. 4), and HRCT showed that the shadows had disappeared (Fig. 2C).