Amiconi Simona, Hirl Bertrand
Department of Anesthesia and Critical Care, Schwabing Hospital, Munich 80804, Germany.
Multidiscip Respir Med. 2014 Jan 30;9(1):7. doi: 10.1186/2049-6958-9-7.
Acute eosinophilic pneumonia (AEP) is a rare febrile illness which is characterized by respiratory failure and often requires mechanical ventilation. The causes and sequence of events of this disease at a biochemical and histological level remain largely unknown. In this article we report the exceptional case, possibly unique, of a patient who developed AEP and three pneumothoraces within less than one month during her hospitalization.
A 39-year-old German woman was admitted to our hospital for a laparoscopy-assisted vaginal hysterectomy under general anaesthesia. The surgical intervention was followed by peritonitis in the early postoperative course. Following anaesthesia induction with propofol/midazolam and during the prolonged therapy with several broad-spectrum antibiotics, she developed AEP and three spontaneous (one left-sided and two right-sided) pneumothoraces, the latter ones observed in quick succession. Symptoms, laboratory markers, and chest radiology significantly improved after a one-day treatment with methylprednisolone.
On the whole, these pathological occurrences, together with similar cases reported in literature, can support the conclusion of possible predisposing genetic factors at the lung tissue level of AEP patients, a view that might shed new light on the pathogenesis of this disease. To provide a coherent pattern that explains the reported evidence for AEP and pneumothoraces, independently from the causative stimulus, the supposed molecular mutations could be localized in the connective tissue rather than in the epithelial cells. In order to interpret clinical and laboratory evidence, as well as to support the main conclusions, the important part of scientific research here presented can also assist physicians in making more informed decisions for the treatment of patients with pulmonary infiltrates.
急性嗜酸性粒细胞性肺炎（AEP）是一种罕见的发热性疾病，其特征为呼吸衰竭，常需机械通气。该疾病在生化和组织学水平上的病因及发病过程仍 largely 未知。在本文中，我们报告了一例特殊病例，可能是独一无二的，一名患者在住院不到一个月的时间内发生了 AEP 并出现了三次气胸。
一名 39 岁的德国女性因在全身麻醉下进行腹腔镜辅助阴道子宫切除术入住我院。术后早期出现了腹膜炎。在用丙泊酚/咪达唑仑诱导麻醉后，以及在使用多种广谱抗生素进行长时间治疗期间，她发生了 AEP 和三次自发性气胸（一次左侧，两次右侧），后两次气胸相继出现。使用甲泼尼龙治疗一天后，症状、实验室指标和胸部影像学表现均有显著改善。
总体而言，这些病理情况，连同文献中报道的类似病例，可支持在 AEP 患者肺组织水平可能存在易感遗传因素的结论，这一观点可能为该疾病的发病机制提供新的线索。为了提供一个连贯的模式来解释报道的 AEP 和气胸的证据，独立于致病刺激因素，推测的分子突变可能定位于结缔组织而非上皮细胞。为了解释临床和实验室证据，并支持主要结论，这里呈现的科学研究的重要部分也可协助医生在治疗肺部浸润患者时做出更明智的决策。
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