[A case of eosinophilic pneumonia presenting as hemoptysis, with epithelioid cell granuloma on lung biopsy].

A 60-year-old woman was admitted because of hemoptysis and dyspnea on exertion, which began one month before admission and gradually increased. Chest X-ray film taken on admission showed an infiltrative shadow in and around the left posterior basal segment. Chest CT disclosed peripheral and patchy consolidation with some air bronchograms and interstitial thickening in the left basal segments. Bronchoalveolar lavage fluid contained many red blood cells and abnormally high numbers of eosinophils and lymphocytes. The specimen obtained by CT-guided lung biopsy revealed epithelioid cell granulomas, hemosiderin-laden macrophages, diffuse infiltration of small round cells with a few eosinophils and monocytes in the alveolar septa, and many eosinophils in the intraalveolar exudates. No pathogens of pulmonary eosinophilia were identified and there was no secondary pulmonary eosinophilia. Therefore, we diagnosed eosinophilic pneumonia with no obvious cause. Hemoptysis may have been due to alveolar hemorrhage of eosinophilic pneumonia. The hemoptysis and chest infiltrative shadow disappeared rapidly after the start of treatment with oral prednisolone.