Eosinophilic Pneumonias, a Rare Case at Paediatric Age

Eosinophilic pneumonias (EP) are a heterogeneous group of pulmonary diseases, characterized by alveolar eosinophilia and/or eosinophilia in peripheral blood.

A non-smoker 14-year-old female, with family history of asthma, diagnosed with asthma in January 2018 and medicated with inhaled fluticasone/salmeterol. In August 2018, was medicated with azithromycin and hydroxyzine due to dyspnea, dry cough and interdigital itchy skin lesions in the hands and feet, with no fever. For persistent symptoms, 5 days later performed a chest X-ray which revealed bilateral infiltrates and was discharged with oral amoxicillin/clavulanate, clemastine and inhaled salbutamol. She returned 5 days later, with no improvement, had wheezing, leukocytosis (23600/μl), eosinophilia (11400/μl) and elevated sedimentation rate (37mm/h). A second chest X-ray was similar and thoracic scan showed perihilar mediastinal adenopathies, bilateral multiple peripheral consolidation focus and air-trapping and small volume pericardial effusion. She was admitted with bronchodilatador treatment. In D1, due to severe worsening of dyspnea, started prednisolone 60mg, with prompt clinical improvement. Further analytical investigation only revealed increased total IgE (1552IU/mL). All other immunological and microbiological (bacterial, mycobacterial, viral, fungal and parasitological) markers were negative. Bronchofibroscopy with bronchoalveolar lavage: 51% eosinophils, negative mycobacterial and microbiological cultures. Bronchial biopsy: inflammatory infiltrate of eosinophils. Echocardiogram confirmed small volume pericardial effusion. The most likely etiologic diagnosis was Chronic Eosinophilic Pneumonia (CEP). After 1.5 months, she had clinical and analytical improvement under corticotherapy (CT), with normal chest X-ray, no peripherial or alveolar eosinophilia and without pericardial effusion. After 6 months, she is in a weaning scheme of CT, without relapses.

In Eosinophilic Pneumonia, etiologic diagnosis is a challenge. The CEP hypothesis was established in the setting of the clinical history, peripheral and alveolar eosinophilia, chest radiographic findings, good response to CT and exclusion of other entities. Treatment consists of prolonged CT but there is still no consensus regarding dosage and duration.