Idiopathic Chronic Eosinophilic Pneumonia Evolving to Pulmonary Fibrosis: A Retrospective Analysis Eosinophilic Pneumonia and Fibrosis

Main Article Content

Misbah Baqir
Tobias Peikert
Tucker Johnson
Yasmeen Tandon
Eunhee Yi
Darrell Schroeder
Jay Ryu

Keywords

eosinophilia; eosinophilic alveolitis; interstitial lung disease

Abstract

Background: Patients with idiopathic chronic eosinophilic pneumonia (ICEP) may have pulmonary fibrosis.


Objectives: To investigate the predictors of pulmonary fibrosis in ICEP, to describe the timeline of pulmonary fibrosis after ICEP diagnosis, and to detail the radiologic pattern of fibrosis.


Methods: A retrospective computer-assisted search was performed to identify patients with ICEP seen at Mayo Clinic in Rochester, Minnesota from January 1, 1997, through September 1, 2019. Patients with follow-up chest computed tomography (CT) beyond 12 months after the ICEP diagnosis were included in the study. Demographic, clinical, radiologic, and histopathologic characteristics were analyzed. Proportional hazards regression was used to assess the predictors of pulmonary fibrosis.


Results: We identified 62 patients (mean [SD] age at ICEP diagnosis, 60 [13] years; female sex, 37 [60%]). Cough (87%) and shortness of breath (85%) were the most common presenting symptoms. Of patients, 27 (44%) had a history of smoking and 27 (44%) had a history of asthma. During follow-up, 23 patients (37%) had CT evidence of pulmonary fibrosis, of whom 16 patients (70%) had a CT pattern inconsistent with usual interstitial pneumonia. In 29% of the patients, the CT evidence of pulmonary fibrosis developed within 2 years after ICEP. Age and male sex were predictors of pulmonary fibrosis. Of note, a history of asthma decreased the likelihood of pulmonary fibrosis.


Conclusions: Development of pulmonary fibrosis is not uncommon in patients with ICEP, especially older men, and is associated with increased risk of death.

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References

1. Allen JN, Davis WB. Eosinophilic lung diseases. Am J Respir Crit Care Med. 1994;150(5 Pt 1):1423-38. Epub 1994/11/01. doi: 10.1164/ajrccm.150.5.7952571. PubMed PMID: 7952571.
2. Philit F, Etienne-Mastroianni B, Parrot A, Guerin C, Robert D, Cordier JF. Idiopathic acute eosinophilic pneumonia: a study of 22 patients. Am J Respir Crit Care Med. 2002;166(9):1235-9. Epub 2002/10/31. doi: 10.1164/rccm.2112056. PubMed PMID: 12403693.
3. Swartz J, Stoller JK. Acute eosinophilic pneumonia complicating Coccidioides immitis pneumonia: a case report and literature review. Respiration. 2009;77(1):102-6. Epub 2007/10/18. doi: 10.1159/000109977. PubMed PMID: 17940333.
4. Rhee CK, Min KH, Yim NY, Lee JE, Lee NR, Chung MP, et al. Clinical characteristics and corticosteroid treatment of acute eosinophilic pneumonia. Eur Respir J. 2013;41(2):402-9. Epub 2012/05/19. doi: 10.1183/09031936.00221811. PubMed PMID: 22599359.
5. Hayakawa H, Sato A, Toyoshima M, Imokawa S, Taniguchi M. A clinical study of idiopathic eosinophilic pneumonia. Chest. 1994;105(5):1462-6. Epub 1994/05/01. doi: 10.1378/chest.105.5.1462. PubMed PMID: 8181338.
6. Ogawa H, Fujimura M, Matsuda T, Nakamura H, Kumabashiri I, Kitagawa S. Transient wheeze: eosinophilic bronchobronchiolitis in acute eosinophilic pneumonia. Chest. 1993;104(2):493-6. Epub 1993/08/01. doi: 10.1378/chest.104.2.493. PubMed PMID: 8339639.
7. Jantz MA, Sahn SA. Corticosteroids in acute respiratory failure. Am J Respir Crit Care Med. 1999;160(4):1079-100. Epub 1999/10/06. doi: 10.1164/ajrccm.160.4.9901075. PubMed PMID: 10508792.
8. Yoshida K, Shijubo N, Koba H, Mori Y, Satoh M, Morikawa T, et al. Chronic eosinophilic pneumonia progressing to lung fibrosis. Eur Respir J. 1994;7(8):1541-4. Epub 1994/08/01. doi: 10.1183/09031936.94.07081541. PubMed PMID: 7957844.
9. Ivanick MJ, Donohue JF. Chronic eosinophilic pneumonia: a cause of adult respiratory distress syndrome. South Med J. 1986;79(6):686-90. Epub 1986/06/01. doi: 10.1097/00007611-198606000-00009. PubMed PMID: 3754983.
10. Yousem SA. Eosinophilic pneumonia-like areas in idiopathic usual interstitial pneumonia. Mod Pathol. 2000;13(12):1280-4. Epub 2001/01/06. doi: 10.1038/modpathol.3880234. PubMed PMID: 11144923.
11. Gharaee-Kermani M, Phan SH. The role of eosinophils in pulmonary fibrosis (review). Int J Mol Med. 1998;1(1):43-53. Epub 1998/12/16. PubMed PMID: 9852197.
12. Lynch DA, Sverzellati N, Travis WD, Brown KK, Colby TV, Galvin JR, et al. Diagnostic criteria for idiopathic pulmonary fibrosis: a Fleischner Society White Paper. Lancet Respir Med. 2018;6(2):138-53. Epub 2017/11/21. doi: 10.1016/S2213-2600(17)30433-2. PubMed PMID: 29154106.
13. Raghu G, Collard HR, Egan JJ, Martinez FJ, Behr J, Brown KK, et al. An official ATS/ERS/JRS/ALAT statement: idiopathic pulmonary fibrosis: evidence-based guidelines for diagnosis and management. Am J Respir Crit Care Med. 2011;183(6):788-824. Epub 2011/04/08. doi: 10.1164/rccm.2009-040GL. PubMed PMID: 21471066; PubMed Central PMCID: PMC5450933.
14. Schafer JL. Multiple imputation: a primer. Stat Methods Med Res. 1999;8(1):3-15. Epub 1999/05/29. doi: 10.1177/096228029900800102. PubMed PMID: 10347857.
15. Ishiguro T, Takayanagi N, Uozumi R, Tada M, Kagiyama N, Takaku Y, et al. The Long-term Clinical Course of Chronic Eosinophilic Pneumonia. Intern Med. 2016;55(17):2373-7. Epub 2016/09/02. doi: 10.2169/internalmedicine.55.6765. PubMed PMID: 27580536.
16. Marchand E, Etienne-Mastroianni B, Chanez P, Lauque D, Leclerc P, Cordier JF, et al. Idiopathic chronic eosinophilic pneumonia and asthma: how do they influence each other? Eur Respir J. 2003;22(1):8-13. Epub 2003/07/29. doi: 10.1183/09031936.03.00085603. PubMed PMID: 12882444.
17. Marchand E, Reynaud-Gaubert M, Lauque D, Durieu J, Tonnel AB, Cordier JF. Idiopathic chronic eosinophilic pneumonia. A clinical and follow-up study of 62 cases. The Groupe d'Etudes et de Recherche sur les Maladies "Orphelines" Pulmonaires (GERM"O"P). Medicine (Baltimore). 1998;77(5):299-312. Epub 1998/10/17. doi: 10.1097/00005792-199809000-00001. PubMed PMID: 9772920.
18. Suzuki Y, Oyama Y, Hozumi H, Imokawa S, Toyoshima M, Yokomura K, et al. Persistent impairment on spirometry in chronic eosinophilic pneumonia: A longitudinal observation study (Shizuoka-CEP study). Ann Allergy Asthma Immunol. 2017;119(5):422-8 e2. Epub 2017/09/26. doi: 10.1016/j.anai.2017.08.009. PubMed PMID: 28942952.
19. Katoh S, Matsumoto N, Tanaka H, Yasokawa N, Kittaka M, Kurose K, et al. Elevated levels of periostin and TGF-beta1 in the bronchoalveolar lavage fluid of patients with idiopathic eosinophilic pneumonia. Asian Pac J Allergy Immunol. 2020;38(3):208-13. Epub 2019/04/24. doi: 10.12932/AP-111018-0414. PubMed PMID: 31012597.
20. Chung KF, Barnes PJ. Cytokines in asthma. Thorax. 1999;54(9):825-57. Epub 1999/08/24. doi: 10.1136/thx.54.9.825. PubMed PMID: 10456976; PubMed Central PMCID: PMC1745579.
21. Miki K, Miki M, Nakamura Y, Suzuki Y, Okano Y, Ogushi F, et al. Early-phase neutrophilia in cigarette smoke-induced acute eosinophilic pneumonia. Intern Med. 2003;42(9):839-45. Epub 2003/10/02. doi: 10.2169/internalmedicine.42.839. PubMed PMID: 14518673.
22. De Giacomi F, Decker PA, Vassallo R, Ryu JH. Acute eosinophilic pneumonia: correlation of clinical characteristics with underlying cause. Chest. 2017;152(2):379-85. Epub 2017/03/14. doi: 10.1016/j.chest.2017.03.001. PubMed PMID: 28286263.
23. Kumar A, Cherian SV, Vassallo R, Yi ES, Ryu JH. Current concepts in pathogenesis, diagnosis, and management of smoking-related interstitial lung diseases. Chest. 2018;154(2):394-408. Epub 2017/12/10. doi: 10.1016/j.chest.2017.11.023. PubMed PMID: 29222007.
24. Dougherty SC, Ghaus S, Debesa O. Extracorporeal membrane oxygenation in severe acute eosinophilic pneumonia. Front Med (Lausanne). 2019;6:65. Epub 2019/04/27. doi: 10.3389/fmed.2019.00065. PubMed PMID: 31024915; PubMed Central PMCID: PMC6467954.
25. Maia JM, Guedes F, Aragao I, Cardoso T. Eosinophilic pneumonia presenting as life-threatening ARDS. BMJ Case Rep. 2015;2015. Epub 2015/07/08. doi: 10.1136/bcr-2014-207379. PubMed PMID: 26150613; PubMed Central PMCID: PMC4493236.
26. Kisling A, Jones J, Hixson C, Hostler D, Hostler J. Mepolizumab: an alternative therapy for idiopathic chronic eosinophilic pneumonia with glucocorticoid intolerance. Drugs Context. 2020;9. Epub 2020/09/05. doi: 10.7573/dic.2020-5-3. PubMed PMID: 32884574; PubMed Central PMCID: PMC7440848.
27. Sarkis E, Patel S, Burns K, Batarseh H, Mador MJ. Anti-interleukin (IL)-5 as a steroid-sparing agent in chronic eosinophilic pneumonia. J Asthma. 2020;57(1):82-6. Epub 2018/11/18. doi: 10.1080/02770903.2018.1543434. PubMed PMID: 30444149.
28. To M, Kono Y, Yamawaki S, Soeda S, Katsube O, Kishi H, et al. A case of chronic eosinophilic pneumonia successfully treated with mepolizumab. J Allergy Clin Immunol Pract. 2018;6(5):1746-8. Epub 2018/09/12. doi: 10.1016/j.jaip.2018.06.017. PubMed PMID: 30201098.