3017 – IDIOPATHIC EOSINOPHILIA WITH PULMONARY INFILTRATES : A CASE REPORT

Abstract

This case report presents a rare condition of pulmonary infiltrate with eosinophilia syndrome (PIES). Incidence of PIES with bronchial asthma has been reported (5 - 11 %). However, actual incidence rate of idiopathic cases is difficult to ascertain. 82-year-old lady with Type 2 diabetes mellitus, lacunar stroke, paroxysmal atrial tachycardia and pernicious anaemia, presented with occasional dry cough and weight loss. Computed Tomography (CT) thorax showed a dense lesion (diameter of 3.6cm) in the right lung apex with pleural fibrosis. Initially, bronchogenic cancer was suspected, but was not confirmed by biopsy. Two years later, Eosinophilia - eosinophil count of 1328 (40-400) 10E6/L was seen in blood. The lung infiltrate continued to be the same.

PIES is characterized by prominent infiltration of lung parenchyma by eosinophils which release pro-inflammatory cytokines, reactive oxygen species, and cationic proteins, leading to development of pseudo-tumorous lesion and fibrosis. Eosinophilic lung diseases include Loeffler syndrome, Tropical pulmonary eosinophilia, Eosinophilic granulomatous with polyangiitis, and Hypereosinophilic syndrome. Thorough history, physical exam, imaging studies, bronchoscopy, blood and sputum analysis where high levels of an absolute eosinophil count greater than 400 10E6/L is needed to confirm diagnosis.

Elevated C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), interleukin -6 (IL-6), Bronchoalveolar Lavage Fluid Analysis, and plasma cytokines - IL-5, IL-4, IL-13, and tumour necrosis factor-alpha provides valuable insight for diagnosing PIES.

Therefore, in patients with pulmonary lesions and eosinophilia, cytokine tests can facilitate accurate and immediate diagnosis.

However, the cause of PIES in our patient remains idiopathic. The treatment plan established for the patient was symptomatic management and observation.