Idiopathic Chronic Eosinophilic Pneumonia Evolving to Pulmonary Fibrosis: A Retrospective Analysis Eosinophilic Pneumonia and Fibrosis
Main Article Content
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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Misbah Baqir, Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota
Dr Baqir conceived and planned the work that led to the article and had an important role in interpreting the results; abstracted the data and wrote the major portion of the manuscript; made substantive suggestions for revision; and approved the final version.
Tobias Peikert, Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota
Dr Peikert conceived and planned the work that led to the article and had an important role in interpreting the results; supervised the work; wrote the paper and made substantive suggestions for revision; and approved the final version.
Tucker Johnson, Department of Radiology, Mayo Clinic, Rochester, Minnesota
Dr Johnson conceived and planned the work that led to the article and had an important role in interpreting the results; read the chest CT and wrote the radiology portion in the Methods section; wrote the paper and made substantive suggestions for revision; and approved the final version.
Eunhee Yi, Division of Anatomic Pathology, Mayo Clinic, Rochester, Minnesota
Dr Yi conceived and planned the work that led to the article and had an important role in interpreting the results; analyzed the pathology slides and wrote the pathology portion of the Methods section; wrote the paper and made substantive suggestions for revision; and approved the final version.
Darrell Schroeder, Division of Clinical Trial and Biostatistics, Mayo Clinic, Rochester, Minnesota
Mr Schroeder conceived and planned the work that led to the article and had an important role in interpreting the results; analyzed the data and checked for accuracy; and approved the final version.
Jay Ryu, Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota
Dr Ryu conceived and planned the work that led to the article and had an important role in interpreting the results; supervised the work; wrote the paper and made substantive suggestions for revision; and approved the final version.
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