Eosinophilic Pneumonia Medical Slides

Present a structured comparison: AEP — acute onset (<1 month), fever, hypoxemia (may require ventilation), NO peripheral eosinophilia initially (eosinophils are in the lung), BAL eosinophils >25%, bilateral diffuse infiltrates, trigger often identifiable (new smoking, dust exposure, medication), excellent prognosis with steroids, relapse rare. CEP — insidious onset (weeks-months), peripheral eosinophilia usually present (>1000/μL in 90%), BAL eosinophils >40%, classic peripheral predominant consolidations, idiopathic, asthma association (50%), frequent relapse requiring prolonged steroids.

Present the diagnostic criteria: (1) acute febrile illness (≤1 month duration), (2) bilateral diffuse pulmonary infiltrates on CXR, (3) hypoxemia (PaO2 <60 mmHg or SpO2 <90%), (4) BAL eosinophilia >25% (peripheral eosinophilia NOT required — may develop only during recovery), (5) no other identified cause of eosinophilic lung disease (drugs, parasites, fungal infection). Emphasize history of recent inhalational exposure — new-onset cigarette smoking is the most recognized trigger. Response to IV methylprednisolone is dramatic within 24-48 hours.

Present the treatment protocols: AEP — methylprednisolone 60-125 mg IV every 6 hours, rapid clinical improvement in 24-48 hours, switch to oral prednisone 40-60 mg with taper over 2-4 weeks total. Relapse is extremely rare — can often stop trigger (e.g., cease smoking) and not recur. CEP — prednisone 0.5-1 mg/kg/day with taper over 6-12 months, relapse in >50% on taper necessitating prolonged low-dose maintenance (5-10 mg for years). Mepolizumab (anti-IL-5) shows promise as steroid-sparing agent in relapsing CEP based on case series data.