Acute eosinophilic pneumonia: A case report and review of the literature

Objectives: Since its original description in 1989, clinicians have documented many cases of acute eosinophilic pneumonia (AEP), but information regarding the appropriate timing of diagnostic testing and treatment continues to be lacking. As a cause of respiratory failure in relatively young individuals, AEP is one of the few diagnoses that will often dramatically alter the intensivist's current therapy. Evidence for effective therapy is anecdotal and may even suggest that the traditional treatment with steroids offers limited benefit. This review uses a patient with AEP to emphasize certain aspects of this illness and discusses the current literature regarding its features, diagnosis, and treatment. Data Sources: A PubMed search from 1989 to 2008 was conducted using the search terms acute eosinophilic pneumonia, respiratory failure, eosinophilic lung disease, bronchoalveolar lavage, and smoking. Data Extraction: Twenty-two articles were included in this review and ranged from case reports to randomized controlled trials. These studies demonstrate our current knowledge of this disease and, more importantly, emphasize areas in which we are lacking. Conclusions: The diagnostic criteria and treatment of AEP is currently based on data from limited case series. Although these criteria are rigid, a wide variation in symptoms, diagnostic findings, and treatments reported further emphasizes our lack of knowledge regarding the pathophysiology of this illness. Important questions remain regarding this disease, including predisposing factors in patients with AEP and the benefit of treating with steroids. (Crit Care Med 2009; 37:1470-1474).