Department of Internal Medicine 2, Oita University Faculty of Medicine, Oita, Japan.
Allergol Int. 2011 Dec;60(4):551-4. doi: 10.2332/allergolint.11-CR-0314.
Eosinophilic pneumonia comprises a group of lung diseases in which eosinophils appear in increased numbers in the lungs. The distinct etiology of eosinophilic pneumonia is unknown, although the previous case series have indicated a relationship between acute eosinophilic pneumonia and the exposure to exogenous substances including the constituents of cigarettes.
A 60-year-old nonsmoking female, who had started to harvest and sort tobacco leaves two months before presentation, was admitted because of persistent coughing, breathlessness, and general malaise. Her laboratory findings revealed eosinophilia. Chest computed tomography showed nonsegmental airspace consolidations bilaterally. A bronchoalveolar lavage fluid analysis also revealed that the numbers of total cells and eosinophils had increased. Although the urine level of cotinine was within the normal range, positive findings were found in the skin scratch-patch tests using tobacco leaf and its extracts, and a biopsy specimen obtained from the positive site demonstrated infiltration of eosinophils in the dermis. The patient was successfully treated with corticosteroids.
Green tobacco sickness, a type of nicotine poisoning caused by the dermal absorption of nicotine, is a well known occupational illness of tobacco harvesters. Although it is unclear whether the present case could be identified as a subtype of green tobacco sickness, this is the first report of eosinophilic pneumonia occurred in a tobacco harvester which was possibly induced by tobacco leaf exposure.
嗜酸性粒细胞性肺炎是一组肺部疾病，其中肺部嗜酸性粒细胞数量增加。嗜酸性粒细胞性肺炎的明确病因尚不清楚，尽管以前的病例系列表明急性嗜酸性粒细胞性肺炎与暴露于包括香烟成分在内的外源性物质之间存在关系。
一名 60 岁的不吸烟女性，在出现症状前两个月开始收割和分拣烟叶，因持续咳嗽、呼吸困难和全身不适而入院。她的实验室检查结果显示嗜酸性粒细胞增多。胸部计算机断层扫描显示双侧非节段性气腔实变。支气管肺泡灌洗液分析还显示总细胞和嗜酸性粒细胞数量增加。虽然尿中可替宁水平在正常范围内，但烟草叶及其提取物的皮肤划痕试验阳性，阳性部位活检标本显示真皮中有嗜酸性粒细胞浸润。患者经皮质类固醇治疗成功。
绿烟病，一种由皮肤吸收尼古丁引起的尼古丁中毒，是烟草收割者熟知的职业疾病。虽然目前的病例是否可以被确定为绿烟病的一种亚型尚不清楚，但这是首例报告的烟草收割者发生的嗜酸性粒细胞性肺炎，可能与烟叶暴露有关。
