Buddhavarapu Venkata S, Dhillon Gagandeep, Grewal Harpreet, Kashyap Rahul
Hospital Medicine, Banner Medical Group, Banner Health, Phoenix, USA.
Internal Medicine, University of Maryland Baltimore Washington Medical Center (UM BWMC), Glen Burnie, USA.
Cureus. 2023 Jun 18;15(6):e40591. doi: 10.7759/cureus.40591. eCollection 2023 Jun.
Cryptogenic organizing pneumonia (COP) and idiopathic eosinophilic pneumonia (IEP) are two forms of diffuse interstitial lung diseases (ILD) that lead to a rapid respiratory decline in young patients. Both conditions presented with similar clinical and radiological findings, making a clinical diagnosis challenging. They are both considered diagnoses of exclusion, and the treatment for both conditions is high-dose corticosteroids, leading to a quick recovery. Pathological specimens are often required prior to initiating appropriate treatment, leading to significant delays in appropriate therapy and a poorer prognosis. In this case report, we suggest that clinical pearls can be used to establish either diagnosis earlier, which leads to earlier treatment and better outcomes. Our patient presented with an acute respiratory distress syndrome (ARDS) picture, bilateral interstitial infiltrates with peripheral predominance, eosinophilia, and a negative initial infectious and cardiac workup. Based on these findings, we had a high initial suspicion that either COP or IEP was present. Our patient had a bronchoscopy done and was promptly started on steroid therapy soon after, which led to rapid clinical improvement. Pathological specimens were inconclusive, but the patient continued to improve, thereby confirming the presence of either form of ILD. The patient was subsequently discharged home with oxygen and recommended to follow up with a pulmonologist for further outpatient testing and management.
隐源性机化性肺炎（COP）和特发性嗜酸性粒细胞性肺炎（IEP）是弥漫性间质性肺疾病（ILD）的两种形式，可导致年轻患者呼吸功能迅速下降。这两种疾病的临床和影像学表现相似，使得临床诊断具有挑战性。它们都被视为排除性诊断，且两种疾病的治疗方法都是大剂量使用皮质类固醇，可实现快速康复。在开始适当治疗之前通常需要病理标本，这导致适当治疗出现显著延迟且预后较差。在本病例报告中，我们认为临床要点可用于更早地确立这两种诊断，从而实现更早治疗并获得更好的结果。我们的患者表现出急性呼吸窘迫综合征（ARDS）的症状，双侧间质浸润以外周为主，嗜酸性粒细胞增多，且初始感染和心脏检查结果为阴性。基于这些发现，我们最初高度怀疑患者患有COP或IEP。我们的患者接受了支气管镜检查，并在检查后不久迅速开始使用类固醇治疗，这导致了临床症状迅速改善。病理标本结果不明确，但患者持续好转，从而证实存在某种形式的ILD。患者随后携带氧气出院，并被建议随访肺科医生以进行进一步的门诊检查和治疗。
