Correct!
5. All of the above
A number of infectious and noninfectious causes can result in eosinophilic pneumonia (5). Most of the infectious causes are parasites and include ascaris, hookworm, schistosomiasis, and strongyloidiasis. The later can result in serious, potentially fatal pulmonary infections in the context of the hyperinfection syndrome, resulting from heavy parasite burdens. This is most often seen in immunocompromised hosts with deficiencies in cell-mediated immunity.
The noninfectious causes include an allergic reaction, exposures to a drug or toxin and a number of idiopathic causes (chronic eosinophilic pneumonia, acute eosinophilic pneumonia, Churg-Strauss syndrome, hypereosinophilic syndrome). The most likely diagnosis appears to be acute eosinophilic pneumonia. However, allergic bronchopulmonary aspergillosis (ABPA) can closely mimic acute eosinophilic pneumonia. The IgE is usually markedly elevated in ABPA, and practically speaking, a normal IgE excludes the diagnosis. Our patient’s IgE was normal.
We identified 2 other case reports of acute eosinophilic pneumonia following naltrexone injection (1, 6). We speculate that the dose of methylprednisolone given in the emergency department lowered the eosinophil percentage in her BAL to slightly below what is usually seen in acute eosinophilic pneumonia. Our patient was continued on corticosteroids and her clinical findings and chest x-ray rapidly improved (Figure 4).
Figure 4. Follow-up PA chest radiograph.
References