Tazelaar H D, Linz L J, Colby T V, Myers J L, Limper A H
Division of Anatomic Pathology, Mayo Clinic, Rochester, Minnesota 55905, USA.
Am J Respir Crit Care Med. 1997 Jan;155(1):296-302. doi: 10.1164/ajrccm.155.1.9001328.
Acute eosinophilic pneumonia is characterized by acute respiratory insufficiency, hypoxemia, fever, diffuse radiographic infiltrates, and eosinophilia in bronchoalveolar lavage fluid (BALF) or lung biopsies in the absence of infection, atopy, or asthma. A rapid response to corticosteroids is characteristic. We reviewed our experience with nine cases of acute lung disease with histologic features of acute and organizing diffuse alveolar damage and prominent interstitial and alveolar eosinophils in order to determine whether this pathology was characteristic of acute eosinophilic pneumonia. The mean age of the patients (four men and five women) was 53 yr (range: 33 to 71 yr). They presented with 2 to 21 d of dyspnea, cough, myalgias, and fever. All were hypoxic and had bilateral infiltrates on chest radiographs. Peripheral blood eosinophilia was present in four of eight patients (peripheral blood count unavailable for one patient). All patients were treated with high-dose corticosteroids with a mean time to symptomatic and radiographic improvement of 4 d. Seven of the nine patients enrolled in the study are alive without relapse; one patient has a mild deficit in diffusing capacity, and one patient died of a myocardial infarct while improving on therapy. The presence of eosinophils in cases of acute respiratory insufficiency due to diffuse alveolar damage (DAD) should suggest the diagnostic possibility of acute eosinophilic pneumonia. Acute eosinophilic pneumonia should be distinguished from other causes of DAD because of important differences in natural history.
急性嗜酸性粒细胞性肺炎的特征为急性呼吸功能不全、低氧血症、发热、弥漫性影像学浸润，以及在无感染、特应性或哮喘情况下支气管肺泡灌洗液（BALF）或肺活检中出现嗜酸性粒细胞增多。对皮质类固醇激素迅速起效是其特点。我们回顾了9例具有急性和机化性弥漫性肺泡损伤组织学特征以及显著间质和肺泡嗜酸性粒细胞的急性肺疾病病例，以确定这种病理表现是否为急性嗜酸性粒细胞性肺炎所特有。患者（4名男性和5名女性）的平均年龄为53岁（范围：33至71岁）。他们出现了2至21天的呼吸困难、咳嗽、肌痛和发热。所有患者均有低氧血症，胸部X线片显示双侧浸润。8例患者中有4例外周血嗜酸性粒细胞增多（1例患者外周血细胞计数未提供）。所有患者均接受了大剂量皮质类固醇激素治疗，症状和影像学改善的平均时间为4天。纳入研究的9例患者中有7例存活且未复发；1例患者弥散功能有轻度缺陷，1例患者在治疗改善过程中死于心肌梗死。因弥漫性肺泡损伤（DAD）导致急性呼吸功能不全的病例中嗜酸性粒细胞的存在应提示急性嗜酸性粒细胞性肺炎的诊断可能性。由于自然病程存在重要差异，急性嗜酸性粒细胞性肺炎应与DAD的其他病因相鉴别。
