SHM Converge Scientific Abstract ePoster Gallery-Chronic Eosinophilic Pneumonia Without Peripheral Eosinophilia

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This case describes a 62-year-old woman with a history of breast cancer treated one year earlier with lumpectomy, radiation, and hormonal therapy. She presented with 1.5 months of cough, fever, night sweats, weight loss, and worsening shortness of breath. Outpatient PET imaging had shown FDG-avid pulmonary nodules and mediastinal lymphadenopathy, raising concern for malignancy or infection.<br /><br />Her background included being born in China, remote travel, and environmental exposures from gardening and composting. On exam, she was hypoxemic with fine crackles, especially in the right lower lung. Workup showed elevated inflammatory markers but negative testing for tuberculosis, autoimmune disease, endemic fungal infection, and viral respiratory pathogens. Notably, peripheral eosinophilia was absent.<br /><br />Chest CT demonstrated multilobar peripheral pulmonary consolidations, a pattern suggestive of chronic eosinophilic pneumonia (CEP). Because the lack of peripheral eosinophilia made the diagnosis less straightforward and cryptogenic organizing pneumonia remained a consideration, she underwent video-assisted thoracoscopic lung biopsy. Pathology showed prominent eosinophils with organization and fibrin, confirming CEP; stains for bacteria and acid-fast organisms were negative.<br /><br />She was started on corticosteroids at 1 mg/kg and improved rapidly. Follow-up CT two months later showed significant improvement in pulmonary infiltrates.<br /><br />The report highlights that CEP is a rare inflammatory lung disease characterized by eosinophilic infiltration of the alveoli and interstitium. It often presents subacutely over weeks with peripheral, “photonegative” infiltrates on imaging. While peripheral blood eosinophilia is common, this case demonstrates that CEP can occur without it. Prior chest radiation, especially in patients with breast cancer, may be associated with CEP. Corticosteroids remain the mainstay of treatment.

Asset Subtitle

Alexander Shaffer

Meta Tag

Author List Alexander Shaffer, Gregory Chionchio, Suhwoo Bae, Syed E. Ahmad

Category Clinical Vignettes

Concept Chronic Eosinophilic Pneumonia

Concept Peripheral Pulmonary Consolidation

Concept Corticosteroids

Concept Subacute Respiratory Symptoms

Concept Multilobar Pulmonary Consolidation

Distinguished Non-Finalist

Presenter Organization Northwell/ NSLIJ

Presenting Author Alexander Shaffer

Track Adult

Keywords

chronic eosinophilic pneumonia

breast cancer

pulmonary consolidations

eosinophilic infiltration

corticosteroid therapy

mediastinal lymphadenopathy

FDG-avid nodules

lung biopsy

hypoxemia

radiation therapy

Chronic Eosinophilic Pneumonia

Peripheral Pulmonary Consolidation

Corticosteroids

Subacute Respiratory Symptoms

Multilobar Pulmonary Consolidation