Correct!
4. A + C
The lung biopsy (Figure 5) shows acute lung injury, with organizing pneumonia, with scattered eosinophils (arrows) within the interstitium and occasionally alveoli.
Figure 5. Representative images from open lung biopsy with arrows indicating collections of eosinophils.
Some of the alveolar spaces show the presence of numerous macrophages and occasional neutrophils. The presence of eosinophils with or without macrophages, lymphocytes, neutrophils in the lung biopsy is considered diagnostic of pulmonary eosinophilia.
As we mentioned last month there are numerous causes of pulmonary eosinophilia in addition to eosinophilic pneumonia including interstitial diseases, infections, toxins and drugs (1). Larsen et al. (2) recently reported four cases of eosinophilic pneumonia associated with amiodarone. Two of the cases were classified as acute eosinophilic pneumonia and two were classified as chronic eosinophilic pneumonia.
Our patient was started on high dose corticosteroids (methylprednisolone 125 mg q 6 hr) and antibiotics were stopped after a 14 day course with exception of fluconazole. She has very slowly improved on tapering doses of corticosteroids. Although patients with idiopathic acute eosinophilic pneumonia often dramatically improve with corticosteroids (3), this patient might have shown slow improvement because of the very long half-life of amiodarone in the lung.
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