Chronic eosinophilic pneumonia (CEP) is a disease of unknown etiology and characterized by pathological, chronic accumulation of eosinophils in the lung.
(See also overview of eosinophilic lung disease.)
Chronic eosinophilic pneumonia (CEP) is a disease of unknown etiology and characterized by pathological, chronic accumulation of eosinophils in the lung. (See also overview of eosinophilic lung disease.) CEP is not really chronic, but rather an acute or subacute disease that occurs repeatedly (hence might be a better name recurrent eosinophilic pneumonia). The prevalence and incidence of CEP are unknown. The cause an allergic diathesis is suspected. Most patients are Non smoking. Symptoms and signs Patients often present with fulminant disease that is accompanied by cough, fever, shortness of breath increases, wheezing and night sweats. The clinical picture may suggest a community-acquired pneumonia. Asthma occurs in> 50% of cases at the same time or is already available. In patients with recurrent symptoms a weight loss may occur. Diagnostic chest X-ray exclusion of infectious causes of pneumonia lavage The suspected diagnosis is made in patients with characteristic symptoms and typical radiographic findings. Diagnosis requires a blood count, ESR, sometimes study of iron levels and exclusion of infectious causes by respective cultures. Peripheral eosinophilia, a very high ESR, iron deficiency anemia and thrombocytosis are often found. Frequently, bilateral peripheral or the pleura seated shading, most commonly in the middle and upper lung fields, is described as “photographic negative” of pulmonary edema in the chest X-ray. These are almost pathognomonic (although present in <25% of patients). A similar pattern may be present in the CT, but the distribution of consolidation may vary and include unilateral lesions. BAL is performed normally, to confirm the diagnosis. Eosinophils> 40% in bronchoalveolar lavage fluid of high suggestive of CEP; BAL-screening may be helpful to document the disease process. Therapy Systemic corticosteroids Sometimes maintenance treatment with inhaled corticosteroids, oral corticosteroids, or both All patients with CEP respond to corticosteroids iv or orally to; lack of response is an indication of other diagnoses. The therapy is initiated with prednisone 40-60 mg 1 time a day. The clinical improvement is frequently impressive and quickly, often within the first hour 48th A complete regression of symptoms and radiological changes occurs in most patients within 14 days and almost all to within 1 month. Symptoms and simple radiographs are reliable and effective parameters for therapy monitoring. Although a CT for the detection of pathological deviations is more sensitive, the repetition of a CT has no advantage. And peripheral eosinophil counts, ESR and total IgE may be used to monitor the progress under therapy. However, these laboratory values ??are not changed in all patients. Symptomatic or radiological recurrences occur in many cases either after treatment or, less frequently, even after reduction of corticosteroid dose. Relapses can occur months to years after the first disease flare. Thus may be required corticosteroid therapy for long periods of time (years). Inhaled corticosteroids (eg. Fluticasone or as beclomethasone 500-750 mcg 2 times daily) seem to be effective, esp. For the reduction of oral maintenance dose. Recurrences seem neither treatment failure still indicate a worse prognosis and higher mortality. Patients continue to speak to corticosteroids, as good as during the first episode. Some contained in convalescence patients a fixed obstruction may occur. But this change is usually only of borderline clinical significance. CEP sometimes leads to physiologically important restrictive abnormalities in lung function as a result of irreversible fibrosis, but the abnormalities are so weak that CEP is an extremely unusual cause of morbidity and death in general.