Virzì Francesco, Giacopelli Giuseppe, Tutone Paolo, Profera Luigi, Giarratano Antonino, Raineri Santi Maurizio, Tomasello Sandro, Accurso Giuseppe
Unit of Anesthesia, Intensive Care, and Hyperbaric Medicine, Civico Emergency Hospital, Sicily, Partinico, Italy.
Department of Anaesthesia, Intensive Care and Emergency, Policlinico Paolo Giaccone, Sicily, Palermo, Italy.
Respir Med Case Rep. 2025 May 22;56:102238. doi: 10.1016/j.rmcr.2025.102238. eCollection 2025.
Eosinophilic pneumonia is a rare but potentially life-threatening condition characterized by eosinophilic infiltration of the lung parenchyma, which can present as acute respiratory failure. Drug-induced eosinophilic pneumonia (DIEP) has been associated with several medications, though the pathophysiological mechanisms remain incompletely understood. Among antimalarial agents, mefloquine has rarely been implicated in severe pulmonary adverse effects.
We report the case of a 34-year-old previously healthy female who developed acute respiratory failure after completing a prophylactic regimen of mefloquine for malaria prevention. The patient initially presented with fever, dyspnea, and hypoxemia, rapidly progressing to severe respiratory distress requiring invasive mechanical ventilation. Laboratory tests revealed marked eosinophilia, while thoracic computed tomography (CT) demonstrated diffuse ground-glass opacities and nodular infiltrates. Bronchoalveolar lavage (BAL) was positive for Rhinovirus, suggesting a possible interplay between drug-induced hypersensitivity and viral infection. Following corticosteroid therapy and supportive care, the patient's condition improved, with resolution of eosinophilia and radiological abnormalities.
This case highlights the need for heightened clinical suspicion of mefloquine-induced eosinophilic pneumonia in patients presenting with unexplained respiratory symptoms following antimalarial prophylaxis. The pathogenesis may involve immune-mediated reactions and oxidative stress, potentially exacerbated by concurrent infections.
Mefloquine should be considered a potential cause of acute eosinophilic pneumonia, particularly in patients with recent drug exposure. Early recognition and timely management, including drug discontinuation and corticosteroid therapy, are crucial to preventing severe complications and ensuring favorable outcomes.
嗜酸性粒细胞性肺炎是一种罕见但可能危及生命的疾病，其特征为肺实质的嗜酸性粒细胞浸润，可表现为急性呼吸衰竭。药物性嗜酸性粒细胞性肺炎（DIEP）与多种药物有关，但其病理生理机制仍未完全明确。在抗疟药物中，甲氟喹很少引起严重的肺部不良反应。
我们报告一例34岁既往健康的女性，在完成预防疟疾的甲氟喹预防方案后发生急性呼吸衰竭。患者最初表现为发热、呼吸困难和低氧血症，迅速进展为严重呼吸窘迫，需要有创机械通气。实验室检查显示明显的嗜酸性粒细胞增多，而胸部计算机断层扫描（CT）显示弥漫性磨玻璃影和结节状浸润。支气管肺泡灌洗（BAL）检测出鼻病毒阳性，提示药物性超敏反应与病毒感染之间可能存在相互作用。经过糖皮质激素治疗和支持治疗，患者病情改善，嗜酸性粒细胞增多和影像学异常消失。
该病例强调，对于在抗疟预防后出现不明原因呼吸道症状的患者，临床需要提高对甲氟喹诱发嗜酸性粒细胞性肺炎的怀疑。其发病机制可能涉及免疫介导反应和氧化应激，并发感染可能会使其加重。
甲氟喹应被视为急性嗜酸性粒细胞性肺炎的潜在病因，尤其是近期有药物暴露史的患者。早期识别和及时处理，包括停用药物和糖皮质激素治疗，对于预防严重并发症和确保良好预后至关重要。
