PMC4913963_01
Radiologic features of eosinophilic pneumonia in a 56-year-old woman who took mesalazine for suspected ulcerative colitis.. Notes: (A) Chest radiograph before admission (June 17, 2015) shows bilateral minor opacity in the upper lung fields, and (B) chest CT scan (June 27, 2015) reveals peripheral opacity in both lungs; (C) chest radiograph after admission (July 4, 2015) shows deterioration of bilateral opacity and (D) bilateral patchy consolidations with interlobular septal thickening in both lungs on CT scan (July 15, 2015). (E) CT scan upon discharge (August 6, 2015) shows bilateral minor ground glass opacity.. Abbreviation: CT, computed tomography.
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A chest radiograph and computed tomography (CT) scan showed minor peripheral patchy opacity in bilateral upper and mid lungs with a narrowed right costophrenic angle (Figure 1A and B). Chest radiograph showed progressing opacity predominantly in bilateral upper lungs (Figure 1C). Chest CT scan revealed bilateral patchy consolidations with interlobular septal thickening (Figure 1D and 1E). CT scan showed bilateral ground glass opacity (Figure 1E).
Pathological findings.. Notes: (A) Transbronchial biopsy reveals chronic inflammation and exudation of fibrin. (B) Photomicrograph of BALF shows infiltration by eosinophils (arrow), hematoxylin and eosin stain x400. (C) Photomicrograph of bone marrow aspirate shows infiltration by mature eosinophils (arrow), Wright-Giemsa stain x1,000.. Abbreviation: BALF, bronchoalveolar lavage fluid.
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Transbronchial biopsy revealed chronic inflammation and exudation of fibrin (Figure 2A), and bronchoalveolar lavage fluid (BALF) showed 1x106 cells/mL with 18% macrophages, 22% neutrophils, 33% eosinophils, and 27% lymphocytes (Figure 2B). Bone marrow aspirate showed infiltration by mature eosinophils (Figure 2C), but the ratio of promyelocytes to their precursors was normal, and the percentage of eosinophils was 18, with normal morphology.
Changes in eosinophil counts.. Note: Arrow indicates date of mesalazine cessation.. Abbreviation: EOS, eosinophils.
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At 5 weeks of follow-up after discharge, the patient was asymptomatic with a normalized eosinophil count (Figure 3).