Comparison of age, sex and biochemical parameters in patients with eosinophilic and noneosinophilic pleural effusion. Eosinophilic pleural effusion in gnathostomiasis volume. The thionamide was stopped and corticosteroid was started with complete resolution of the pleural effusion in 3 months. Pleural fluid cytology showed exudative pleural effusion with eosinophilia. We report a case of chronic eosinophilic pneumonia. Chest and abdominal computed tomography showed gastrointestinal wall thickening. Three cases of pleural effusion with eosinophilia are presented.
Cytology revealed numerous eosinophils 91% with reactive mesothelial cells and no evidence of malignancy. Furthermore, follow up transthoracic echocardiography showed that pericardial effusion was reduced, and follow up chest xray showed decreased pleural effusion fig. The pleural fluid should be evaluated for infection and malignant cells. Since, in our opinion, eosinophilic pleural effusion epe, and druginduced epe in particular, is an interesting issue, we would like to add some comments to this article. Eosinophilic pleural effusion epe is defined as a pleural effusion containing. A case of eosinophilic pleural effusion induced by. The most common causes of eosinophilic pleural effusion are. A 57yearold hispanic woman, a nonsmoker with a history of controlled asthma.
The temporal relationship between commencing carbimazole and developing a pleural effusion, along with the emergence of a peripheral eosinophilia after starting the drug are in keeping with this diagnosis. Eosinophilic pleural effusions, defined as a pleural effusion that contains at least 10% eosinophils, may be caused by almost every condition that can cause pleural disease. Pleural effusion with eosinophilia journal of allergy. What is the role of pleural fluid eosinophilia in the workup for pleural. Mar 21, 2017 the thionamide was stopped and corticosteroid was started with complete resolution of the pleural effusion in 3 months. Druginduced pleural effusion is a welldescribed entity in the literature.
In consideration of the frequency of pleural effusion in general, it is surprising that so few cases of pleural effusion with a large number of eosinophils have been reported in the literature. This excess fluid can impair breathing by limiting the expansion of the lungs. Incidence and aetiology of eosinophilic pleural effusion european. Echocardiography showed a small amount of pericardial effusion. It is our opinion that this group represents an unusual clinical problem and we encourage reports of additional cases. We report a case of a 26yearold male who presented with shortness of breath. Diagnostic procedure for idiopathic eosinophilic pleural. Diagnostic utility of pleural fluid eosinophilia sciencedirect. Eosinophilic pleural effusions, defined as a pleural effusion that contains at least 10% eosinophils, may be caused by almost every condition that can cause. Hemorrhagic pleural effusion due to pleural hemangioma.
Eosinophilic pleural effusion as the first presentation of. Eosinophilic pleural effusion occurs most commonly during conditions associated with the presence of blood or air in the pleur. Jan 12, 2010 several causes of eosinophilic pleural effusions have been described with malignancy being the commonest cause. Eosinophilic pleural effusions epfs, defined as the presence of 10% or more eosinophils in the pleural fluid, are relatively rare. Research article open access diagnostic procedure for idiopathic eosinophilic pleural effusion. A pleural effusion is excess fluid that accumulates in the pleural cavity, the fluidfilled space that surrounds the lungs. What is the role of pleural fluid eosinophilia in the. Eosinophilic pleural effusion epe is defined by an eosinophil count of. Review pleural effusion postgraduate medical journal.
Druginduced eosinophilic pleural effusion to the editors. Despite the multitude of studies enumerating the causes of eosinophilic pleural effusion epe, 14%25% of such cases remain idiopathic even after thorough workup. Pleural effusion occurs in up to 25% of hiv inpatients and is usually attributable to parapneumonic effusion, tb, kaposis sarcoma, or less commonly lymphoma. In a patient like the one presented here, where the major causes of eosinophilic pleural effusion were excluded and the clinical picture didnt suggest the other minor causes, a drug reaction is worth considering. Epes account for 5 to 16% of exudative pleural effusions. Complete clinical data of 11 consecutive patients with iepe were prospectively collected and analysed. We read with great interest the article by alagha et al. Eosinophilic gastroenteritis the authors 2020 with. Like other cases of chronic eosinophilic pneumonia, early recognition and diagnosis is essential and prompt. Eosinophilic exudative pleural effusion after initiation of. The lack of specificity is mainly due to the limitations of the imaging modality. Chronic eosinophilic pneumonia is a rare idiopathic interstitial lung disease. Diltiazeminduced eosinophilic pleural effusion request pdf. Aug 12, 2016 chronic eosinophilic pneumonia is a rare idiopathic interstitial lung disease.
Churg strauss syndrome presenting as an eosinophilic. It is estimated that approximately 10 percent of exudative pleural effusions are eosinophilic. Several causes of eosinophilic pleural effusions have been described with malignancy being the commonest cause. Pathogenesis of the eosinophilic pleural effusions. Methimazole associated eosinophilic pleural effusion.
Eosinophilic pleural effusion epe is pleural effusion pe in which eosinophils account for more than 10% of pleural fluid pf cellularity. A pleural effusion is defined to be eosinophilic when 10% or more of the white blood cells in pleural fluid are eosinophils. Iatrogenic pleural effusions are not rare but the diagnosis is mostly putative and difficult to ascertain. Jan 30, 2003 eosinophilic pleural effusions epfs, defined as the presence of 10% or more eosinophils in the pleural fluid, are relatively rare.
Eosinophilic pleural effusion and pericarditis with effusion in an allergic subject. Although eosinophilic pleural effusion epe has been a subject of numerous studies, its clinical. International journal of science and research, 2 2. Pdf incidence and aetiology of eosinophilic pleural. He underwent thoracentesis for recurrent left pleural effusion. Eosinophilic pleural effusions epe are present in 710% of all unilateral pleural effusions, and are defined as a pleural eosinophil count 10% on cell diff. The naranjo score was calculated to be 7, indicating that the eosinophilic pleural effusion was. However, these theories have fallen by the wayside in the light of recent publications. Eosinophilic pleural effusion is an uncommon disorder characterized by a very high number of eosinophils, usually more than 10% of the cells. The prevalence and diagnostic significance of eosinophilic pleural.
Carbimazoleinduced eosinophilic pleural effusion bmj. Symptomatic improvement was noted after thoracentesis. Eosinophilic pleural effusion epe has been associated with less risk for malignancy with a potential causal relationship with the presence of air andor blood in. However, eosinophilia is a relatively rare finding in malignant pleural effusions, and it.
The final diagnosis was eosinophilic pleural effusion in a patient with multiple myeloma. On further investigation he was found to have kappa. Eosinophilic pleural effusion occurs most commonly during conditions associated with the presence of. Hypereosinophilic syndrome hes is a rare disease and very few cases have been reported of hes presenting as eosinophilic pleural effusion epe. Eosinophilic pleural effusion a condition with multiple. The causes of this finding are multiple, but, in the individual case or idiopathic occurrence, one should strongly consider the possibility of collagen disease. Open access eosinophilic endomyocarditis combined with. Eosinophilic pleural effusion epe, defined as pleural effusion that contains at least 10% eosinophils among the leukocytes, can be a manifestation of a great variety of diseases. Pleural fluid eosinophilia pfe, also called eosinophilic pleural effusion is defined as pleural fluid with a nucleated cell count containing more than 10 percent eosinophils 14.
Eosinophilic pleural effusion epe is defined as a pleural effusion that contains at least 10% eosinophils. Report of a case treated with pyribenzamine author links open overlay panel nelson zivitz m. Diagnostic value of eosinophils in pleural effusion. Various kinds of pleural effusion, depending on the nature of the fluid and what caused its entry into the pleural space, are hydrothorax serous fluid, hemothorax blood, urinothorax urine. Eosinophilic pleural high activity as a systemic lupus. Awareness of this rare adverse reaction of antithyroid drugs is important and methimazole can be added to the list of possible. Eosinophilic pleural effusions are often benign but can be attributable to underlying malignancy in up to 10% of cases and therefore still needs to be investigated fully. It is estimated that approximately 10 percent of exudative pleural effusions are eosinophilic 2,3,5. We report a case of chronic eosinophilic pneumonia with transudative eosinophilic pleural effusion. Eosinophilic pleural effusion epe has been associated with less risk for malignancy with a potential causal relationship with the presence of air andor blood in the pleural space. The diagnosis of pe includes both noninvasive and invasive approaches. Eosinophilic pleural effusion, th ionamides, methimazole, hypersen sitivity reaction, case.
Epe occurs due to a variety of causes such as blood or air in the pleural space. Pleural fluid eosinophilia pfe, with eosinophil values greater than 10% of nucleated cells, is seen in approximately 10% of pleural effusions and is not correlated with peripheral blood. The naranjo score was calculated to be 7, indicating that the eosinophilic pleural effusion was most probably secondary to adverse reaction from mesalamine. Six additional reports of eosinophilic pleural fluid in rheumatoid arthritis werelater published campbell and ferrington, 1968.
Incidence and aetiology of eosinophilic pleural effusion. Eosinophilic pleural effusion, idiopathic, diagnosis, glucocorticoid, diagnostic procedure background pleural effusion pe is a very common clinical and radiological finding in respiratory medicine 1, 2. Eosinophilic pleural effusion a condition with multiple causes george bower. We believe this is the first case reporting an eosinophilic exudative pleural effusion secondary to carbimazole. However, eosinophilia is a relatively rare finding in malignant pleural effusions, and it has been used as an indicator of good prognosis. Pleural fluid eosinophilia pfe, also called eosinophilic pleural effusion is defined as pleural fluid with a nucleated cell count containing more. Hematological investigations revealed hemoglobin of 15.
Conclusions we report the first case of chronic eosinophilic pneumonia presenting with pneumonia with ipsilateral transudative eosinophilic pleural effusion. Awareness of this rare adverse reaction of antithyroid dr ugs is important and methimazole can be added to the list of possible etiologies of druginduced eosinophilic pleural effusion. Moreover, eosinophilic infiltration was detected in duodenal and rectal biopsy samples that had been collected during endoscopic examination of the upper gastrointestinal. Chronic eosinophilic pneumonia presenting with ipsilateral pleural effusion. Eosinophilic pleural effusion epe is usually defined as a pleural effusion pe that contains. However, there was new multifocal consolidation, groundglass opacification and intralobular septal thickening present throughout the right hemithorax. Carbimazoleinduced eosinophilic pleural effusion bmj case. Chronic pleural effusions are sometimes difficult to manage. Given that most effusions are detected by xray, which generally cannot distinguish between fluid types, the fluid in question maybe. Eosinophilic pleural effusion epe has been associated with less risk for malignancy with a potential causal relationship with the presence of air. These were modified by using bayes rule to estimate the revised probability of disease in the presence of an eosinophilic effusion. Some cases remain unresolved despite invasive investigations. What is the role of pleural fluid eosinophilia in the workup.
Cureus idiopathic eosinophilic pleural effusion treated. Case report unusual presentation of chronic eosinophilic. Pleural fluid eosinophilia pfe, with eosinophil values greater than 10% of nucleated cells, is seen in approximately 10% of pleural effusions and is not. Since, in our opinion, eosinophilic pleural effusion epe, and. Pleural effusion is commonly used as a catchall term to describe any abnormal accumulation of fluid in the pleural cavity. The differential diagnosis for epe includes malignancy, infection, posttraumatic, pneumothorax, pulmonary embolism, autoimmune disease transudative, and asbestosis. Eosinophilic pleural effusion occurs most commonly during conditions associated with the presence of blood or air in the pleural space, infections, and. The nearly pathognomonic radiographic finding is the peripheral distribution of alveolar opacities. Awareness of this rare adverse reaction of antithyroid drugs is important and methimazole can be added to the list of possible etiologies of druginduced eosinophilic pleural effusion. Nayak, deepak m and belurkar, sushma v and srilatha, ps and shastry, indira and solanke, girish 20 churg strauss syndrome presenting as an eosinophilic pleural effusion. The relative incidence of epe has been estimated at between 5% and 16% of all pes 1, 35, but the clinical significance of pleural fluid eosinophilia remains unclear.
Comparison between the malignant and nonmalignant eosinophilic plural effusions. Eosinophilic pleural effusion epe is attributed to several wellrecognised causes. To the editors we read with great interest the article by a lagha et al. This demonstrated complete resolution of the pleural effusion. Secondly, eosinophilic pleural effusion is also unusual in gnathosthosmiasis. Oneofthese had a rheumatoid disease, with positive lecells in the peripheral blood, but the pleural effusion was probably related to pulmonary infarction. Pleural fluid eosinophilia pfe, also called eosinophilic pleural effusion is defined as pleural fluid with a nucleated cell count containing more than 10 percent eosinophils. Eosinophilic pleural effusion as a manifestation of. Eosinophilic pleural effusion and pericarditis with. Symptoms are dependent on the nature of the underlying disease and on the local effects of the fluid. Chronic eosinophilic pneumonia in a 25yearold female with sustained symptoms on conventional treatment. Some cases occur in the setting of a predisposing cause, but in about onethird of cases the origin remains obscure.
Eosinophilic exudative pleural effusion after initiation. Druginduced eosinophilic pleural effusion european. Although eosinophilic pleural effusion epe has been a subject of numerous studies, its clinical significance still remains unclear. Following drainage of the pleural effusion via a chest drain, we performed repeat imaging of the chest. Supraclavicular lymph node biopsy was reported as amyloid. Incidence and aetiology of eosinophilic pleural effusion r. The present of an epe is not indicative of any particular diagnostic category malignancy vs non or particular diagnosis such as tb, for example.
Other biochemical parameters were within normal limits. It is surprising also that the tubercle bacillus as the etiologic agent in these cases has never been. The present study aimed to better characterize idiopathic epe iepe and to outline the diagnostic procedure for this disease. Eosinophilic pleural effusion in gnathostomiasis volume 10. Their diagnostic and prognostic significance, however, remains controversial, as most of the studies are based almost entirely on retrospective case studies.
1101 844 788 664 1463 761 198 1354 665 1024 65 832 1549 926 1073 313 1243 482 1404 372 1115 872 1432 50 61 774 420 395