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Fluctuating, Peripheral Pulmonary Infiltrates
ROENTGENOGRAM OF THE MONTH
Fluctuating, Peripheral Pulmonary Infiltrates Joseph N. Aceto, M.D.,
rc.c.e:
This 42-year-old white woman was seen because
segs, 23 percent lymphocytes; 4 percent eosinophils. The roentgen findings fluctuated in extent and location. Broad spectrum antibiotics, given for ten days , were without effect. During this time, many laboratory studies were conducted and no specific etiologic agent was found .
of cough, temperature of 99 to 100°F , weakness. and excessive sweating. Blood count showed : 4 million rhc; 91 percent Hb; 10,650 wbc, 73 percent "Ohio Valley General Hospital, Wheeling, West Virginia . Rqlrint requests : Dr. Aceto, 104 .\I cadou: Lane, \\1heeling, West Virg inia 26003
FIC;URE
1.
FIGUIIE
289
2.
290
JOSEPH N. ACETO
Diagnosis: Transient Eosinophilic Pneumonia (Loffler's SYI/(Irome: PIE Syndrome) Figures 1 and :2 show a fluctuating change in pattern and extent of the pulmonary infiltrates. This suggested the diagnosis. The eosinophilia was confirmatory, although it fluctuated from 0 to 7 percent. Intravenous arsenicals followed by prolonged administration of adrenocorticosteroids effected complete remission, clinically and roentgenologically. The last film. seven years following the above episode, continued to remain normal. The patient had no allergic history, tests were negative for sensitivity to allergens and stools were negative for parasites. Because of the waxing and waning of the
pulmonary infiltration, lung biopsy did not appear to be indicated. Pulmonary infiltrate with eosinophilia (PIE syndrome) is a clinical syndrome with multiple causes, a great majority of which arc transient. The lung biopsy is the diagnostic procedure of choice for those patients with persistent and localized infiltrate, ie, chronic eosinophilic pneumonitis. Many causes have been listed, including hyperimmune states, parasitic infestation, various types of infection, sensitivity reaction to physical and chemical agents, as well as to drugs. It is commonly associated with the collagen diseases, and malignant neoplasm, notably lymphoma. A peripheral location of the pneumonic infiltrate has been emphasized, the so-called reversed pulmonary edema pattern. Figure 3, taken later in the course hut prior to treatment, is a typical example. Persistent elevation of the eosinophilic count in the peripheral blood is not essential to the diagnosis. REFERENCES
2 3 4 .5 FIGL'RE
.'3 .
Carrington CD, Addington WW, Goff A\[, et al: Chronic eosinophilic pneumonia. New Eng J \[ed 280:787, 1969 Ford H\I : Transient pulmonary eosinophilia and asthma : review of 20 cases occurring in 5,702 asthma sufferers. Amer Hev Resp Dis 93 :797, HJ66 Hardy \VR, Anderson RE : Hypereosinophilic syndromes. Ann Intern \[ed 68: 1220, 1968 Liehow AA, Carrington CB : The eosinophilic pneumonia. Med 48 :2.51, HJ69 Reeder WH, Goodrich BE : Pulmonary infiltration with eosinophilia (PIE syndrome) . Ann Intern Med 36: 1217, H).52
AN NOU NCEM ENTS SIXTH ANNUAL WORKSHOP IN ELECTROCARDIOGRAPHY The Rogers Heart Foundation will present the Sixth Annual Workshop in Electrocardiography at The Tides lIotel and Bath Club, Redington Beach, Florida , June 5-10, 1972. Dr. Henry J. L. Marriott is workshop director. For further information, please write The Rogers Heart Foundation, St. Anthony's Hospital. St. Petersburg. Florida 33705 .
TUBERCULOSIS TODAY The 1972 schedule for Tuberculosis Today courses, presented at the Center for Disease Control, Atlanta, is: April 10-14; June 12-16; July 31-August 4; October 16-20; December 4-8. There is no fee and the courses are open to managers of tuberculosis control programs and for personnel responsible for tuberculosis teaching in health departments, medical schools, schools of nursing and public health, and hospitals which admit and treat tuberculosis patients . For information , write : Phyllis Q. Edwards, M.D., Chief, Tuberculosis Branch, State and Community Services Division, CDC, Atlanta, Georgia 30333.
22ND STUDENT AMA ANNUAL MEETING The 22nd Annual Meeting of the Student American Medical Association will be held at the Biltmore Hotel, Los Angeles, April 28-May 1, 1972. For information, write : SA~1A, 1400 Hicks Road, Rolling Meadows, Illinois 60008 .
CHEST, VOL. 61, NO.3, MARCH, 1972
Fluctuating, Peripheral Pulmonary Infiltrates Joseph N. Aceto, M.D.,
rc.c.e:
This 42-year-old white woman was seen because
segs, 23 percent lymphocytes; 4 percent eosinophils. The roentgen findings fluctuated in extent and location. Broad spectrum antibiotics, given for ten days , were without effect. During this time, many laboratory studies were conducted and no specific etiologic agent was found .
of cough, temperature of 99 to 100°F , weakness. and excessive sweating. Blood count showed : 4 million rhc; 91 percent Hb; 10,650 wbc, 73 percent "Ohio Valley General Hospital, Wheeling, West Virginia . Rqlrint requests : Dr. Aceto, 104 .\I cadou: Lane, \\1heeling, West Virg inia 26003
FIC;URE
1.
FIGUIIE
289
2.
290
JOSEPH N. ACETO
Diagnosis: Transient Eosinophilic Pneumonia (Loffler's SYI/(Irome: PIE Syndrome) Figures 1 and :2 show a fluctuating change in pattern and extent of the pulmonary infiltrates. This suggested the diagnosis. The eosinophilia was confirmatory, although it fluctuated from 0 to 7 percent. Intravenous arsenicals followed by prolonged administration of adrenocorticosteroids effected complete remission, clinically and roentgenologically. The last film. seven years following the above episode, continued to remain normal. The patient had no allergic history, tests were negative for sensitivity to allergens and stools were negative for parasites. Because of the waxing and waning of the
pulmonary infiltration, lung biopsy did not appear to be indicated. Pulmonary infiltrate with eosinophilia (PIE syndrome) is a clinical syndrome with multiple causes, a great majority of which arc transient. The lung biopsy is the diagnostic procedure of choice for those patients with persistent and localized infiltrate, ie, chronic eosinophilic pneumonitis. Many causes have been listed, including hyperimmune states, parasitic infestation, various types of infection, sensitivity reaction to physical and chemical agents, as well as to drugs. It is commonly associated with the collagen diseases, and malignant neoplasm, notably lymphoma. A peripheral location of the pneumonic infiltrate has been emphasized, the so-called reversed pulmonary edema pattern. Figure 3, taken later in the course hut prior to treatment, is a typical example. Persistent elevation of the eosinophilic count in the peripheral blood is not essential to the diagnosis. REFERENCES
2 3 4 .5 FIGL'RE
.'3 .
Carrington CD, Addington WW, Goff A\[, et al: Chronic eosinophilic pneumonia. New Eng J \[ed 280:787, 1969 Ford H\I : Transient pulmonary eosinophilia and asthma : review of 20 cases occurring in 5,702 asthma sufferers. Amer Hev Resp Dis 93 :797, HJ66 Hardy \VR, Anderson RE : Hypereosinophilic syndromes. Ann Intern \[ed 68: 1220, 1968 Liehow AA, Carrington CB : The eosinophilic pneumonia. Med 48 :2.51, HJ69 Reeder WH, Goodrich BE : Pulmonary infiltration with eosinophilia (PIE syndrome) . Ann Intern Med 36: 1217, H).52
AN NOU NCEM ENTS SIXTH ANNUAL WORKSHOP IN ELECTROCARDIOGRAPHY The Rogers Heart Foundation will present the Sixth Annual Workshop in Electrocardiography at The Tides lIotel and Bath Club, Redington Beach, Florida , June 5-10, 1972. Dr. Henry J. L. Marriott is workshop director. For further information, please write The Rogers Heart Foundation, St. Anthony's Hospital. St. Petersburg. Florida 33705 .
TUBERCULOSIS TODAY The 1972 schedule for Tuberculosis Today courses, presented at the Center for Disease Control, Atlanta, is: April 10-14; June 12-16; July 31-August 4; October 16-20; December 4-8. There is no fee and the courses are open to managers of tuberculosis control programs and for personnel responsible for tuberculosis teaching in health departments, medical schools, schools of nursing and public health, and hospitals which admit and treat tuberculosis patients . For information , write : Phyllis Q. Edwards, M.D., Chief, Tuberculosis Branch, State and Community Services Division, CDC, Atlanta, Georgia 30333.
22ND STUDENT AMA ANNUAL MEETING The 22nd Annual Meeting of the Student American Medical Association will be held at the Biltmore Hotel, Los Angeles, April 28-May 1, 1972. For information, write : SA~1A, 1400 Hicks Road, Rolling Meadows, Illinois 60008 .
CHEST, VOL. 61, NO.3, MARCH, 1972