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The Mighty Eosinophil

Case Editor - Judd Flesch

Reviewed By Allergy, Immunology & Inflammation Assembly

Submitted by

Mahoney AJ, Wirtz DJ, Allen JN

The Division of Pulmonary Allergy Critical Care & Sleep Medicine

The Ohio State University College of Medicine

Columbus, Ohio

Submit your comments to the author(s).

History

The patient is a 65 year-old gentleman with history of asthma who was admitted to the hospital after being evaluated by his primary care physician (PCP) for one week of progressively worsening dyspnea on exertion.  He uses an albuterol inhaler for mild intermittent asthma symptoms; however, for the last week his dyspnea had not been responsive to bronchodilators. At his PCP’s office, pulse oximetry showed him to be hypoxemic on room air. He denied fever, but had night sweats and chills. He did not have any significant cough or sputum production. Just prior to admission, he developed a maculopapular rash on his trunk and legs.

Of note, he underwent right total knee arthroplasty (TKA) two months prior to this presentation.  This was complicated by an MRSA wound infection and right lower extremity cellulitis, for which he had been receiving intravenous daptomycin for the last two weeks. At the time of the current presentation, the wound was healing well, and he had only a small wound on the lateral part of his leg, which he packed daily.

Physical Exam

The patient had a BMI of 30. Vital signs were within normal limits except for an oxygen saturation of 87% on room air. Cardiac exam was normal. Auscultation of the lung fields revealed moist crackles bilaterally. He had a nonpruritic, maculopapular, erythematous rash on his legs and lower trunk with discrete lesions measuring 2-4 mm. Extremities revealed no cyanosis or clubbing.

figure1

Chest radiograph on admission is shown in figure 1.

figure 2

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figure 4

Chest computed tomography (CT) on admission is shown in figures 2,3,4.

Laboratories were performed and revealed the following: white blood count 6 K/uL, hemogloblin 9.3 g/dL, platelet count 295 K/uL. White blood cell differential included 66% neutrophils, 17% lymphocytes, 6 % monocytes, and 10 % eosinophils. The absolute eosinophil count was 600. Serum chemistries were within normal limits.

Question 1

WHICH OF THE FOLLOWING DISEASES/DISORDERS COMMONLY PRESENT WITH PERIPHERAL EOSINOPHILIA AND PULMONARY INFILTRATES?


References

  1. Allen, James. “Acute Eosinophilic Pneumonia.” Seminars in Respiratory and Critical Care Medicine. 2006. 27:2, 142-147.
  2. Kalogeropoulos, Andreas et al. “Eosinophilic pneumonia associated with daptomycin: a case report and review of the literature.” Journal of Medical Case Reports. 2011. 5:13.
  3. Lal, Yasir et al. “Two Cases of Daptomycin-induced Eosinophilic Pneumonia and Chronic Pneumonitis.” Clinical Infectious Diseases. 2010. 50:1, 737-740.
  4. Lee, Sang-Pyo et al. “A case of Mexilitine-induced Hypersensitivity Syndrome Presenting with Eosinophilic Pneumonia.” Journal of Korean Medical Science. 2010. 25:1, 148-151.
  5. Miller, Becky et al. “Acute Eosinophilic Pneumonia Secondary to Daptomycin: A Report of Three Cases.” Clinical Infectious Diseases. 2010. 50:11, e63-e68.