Epe occurs due to a variety of causes such as blood or air in the pleural space. Eosinophilic pleural effusion epe is attributed to several wellrecognised causes. However, these theories have fallen by the wayside in the light of recent publications. The naranjo score was calculated to be 7, indicating that the eosinophilic pleural effusion was most probably secondary to adverse reaction from mesalamine. Eosinophilic pleural effusion as a manifestation of. Eosinophilic pleural effusion epe, defined as pleural effusion that contains at least 10% eosinophils among the leukocytes, can be a manifestation of a great variety of diseases. Awareness of this rare adverse reaction of antithyroid dr ugs is important and methimazole can be added to the list of possible etiologies of druginduced eosinophilic pleural effusion. Oneofthese had a rheumatoid disease, with positive lecells in the peripheral blood, but the pleural effusion was probably related to pulmonary infarction. We report a case of chronic eosinophilic pneumonia. Jan 12, 2010 several causes of eosinophilic pleural effusions have been described with malignancy being the commonest cause. A pleural effusion is defined to be eosinophilic when 10% or more of the white blood cells in pleural fluid are eosinophils.
Pleural fluid eosinophilia pfe, also called eosinophilic pleural effusion is defined as pleural fluid with a nucleated cell count containing more than 10 percent eosinophils 14. Awareness of this rare adverse reaction of antithyroid drugs is important and methimazole can be added to the list of possible etiologies of druginduced eosinophilic pleural effusion. We report a case of chronic eosinophilic pneumonia with transudative eosinophilic pleural effusion. Diagnostic value of eosinophils in pleural effusion. The nearly pathognomonic radiographic finding is the peripheral distribution of alveolar opacities. Multiple myeloma presenting as eosinophilic pleural effusion. Eosinophilic gastroenteritis the authors 2020 with. Eosinophilic pleural effusion a condition with multiple. Eosinophilic pleural effusion epe is defined as a pleural effusion containing.
Report of a case treated with pyribenzamine author links open overlay panel nelson zivitz m. Eosinophilic exudative pleural effusion after initiation. Eosinophilic pleural effusion, idiopathic, diagnosis, glucocorticoid, diagnostic procedure background pleural effusion pe is a very common clinical and radiological finding in respiratory medicine 1, 2. Eosinophilic pleural effusion a condition with multiple causes george bower. Chronic pleural effusions are sometimes difficult to manage. Although reported as a potential cause in reference books, a medline search key words. Diagnostic utility of pleural fluid eosinophilia sciencedirect.
Eosinophilic pleural effusion epe is defined as a pleural effusion that contains at least 10% eosinophils. The diagnosis of pe includes both noninvasive and invasive approaches. Mar 21, 2017 the thionamide was stopped and corticosteroid was started with complete resolution of the pleural effusion in 3 months. Eosinophilic pleural effusion epe has been associated with less risk for malignancy with a potential causal relationship with the presence of air andor blood in. It is estimated that approximately 10 percent of exudative pleural effusions are eosinophilic. Some cases occur in the setting of a predisposing cause, but in about onethird of cases the origin remains obscure. Eosinophilic pleural effusion epe is defined by an eosinophil count of. However, there was new multifocal consolidation, groundglass opacification and intralobular septal thickening present throughout the right hemithorax. Research article open access diagnostic procedure for idiopathic eosinophilic pleural effusion. Pleural effusion occurs in up to 25% of hiv inpatients and is usually attributable to parapneumonic effusion, tb, kaposis sarcoma, or less commonly lymphoma. Although eosinophilic pleural effusion epe has been a subject of numerous studies, its clinical. The thionamide was stopped and corticosteroid was started with complete resolution of the pleural effusion in 3 months.
Symptomatic improvement was noted after thoracentesis. Eosinophilic pleural effusion is an uncommon disorder characterized by a very high number of eosinophils, usually more than 10% of the cells. A 57yearold hispanic woman, a nonsmoker with a history of controlled asthma. However, eosinophilia is a relatively rare finding in malignant pleural effusions, and it. Eosinophilic pleural effusion occurs most commonly during conditions associated with the presence of blood or air in the pleur. Aug 12, 2016 chronic eosinophilic pneumonia is a rare idiopathic interstitial lung disease. Conclusions we report the first case of chronic eosinophilic pneumonia presenting with pneumonia with ipsilateral transudative eosinophilic pleural effusion. Pleural fluid eosinophilia pfe, also called eosinophilic pleural effusion is defined as pleural fluid with a nucleated cell count containing more than 10 percent eosinophils. Epes account for 5 to 16% of exudative pleural effusions.
The most common causes of eosinophilic pleural effusion are. Eosinophilic pleural effusion and pericarditis with effusion in an allergic subject. It is our opinion that this group represents an unusual clinical problem and we encourage reports of additional cases. Hypereosinophilic syndrome hes is a rare disease and very few cases have been reported of hes presenting as eosinophilic pleural effusion epe. Eosinophilic pleural effusion in gnathostomiasis volume. Some cases remain unresolved despite invasive investigations. The lack of specificity is mainly due to the limitations of the imaging modality. The differential diagnosis for epe includes malignancy, infection, posttraumatic, pneumothorax, pulmonary embolism, autoimmune disease transudative, and asbestosis. Methimazole associated eosinophilic pleural effusion. Several causes of eosinophilic pleural effusions have been described with malignancy being the commonest cause. Diltiazeminduced eosinophilic pleural effusion request pdf.
On further investigation he was found to have kappa. Eosinophilic pleural effusion epe is pleural effusion pe in which eosinophils account for more than 10% of pleural fluid pf cellularity. Druginduced eosinophilic pleural effusion european. Eosinophilic pleural effusion occurs most commonly during conditions associated with the presence of. Chest and abdominal computed tomography showed gastrointestinal wall thickening. Eosinophilic pleural effusion, th ionamides, methimazole, hypersen sitivity reaction, case.
The final diagnosis was eosinophilic pleural effusion in a patient with multiple myeloma. Like other cases of chronic eosinophilic pneumonia, early recognition and diagnosis is essential and prompt. He underwent thoracentesis for recurrent left pleural effusion. It is surprising also that the tubercle bacillus as the etiologic agent in these cases has never been. Furthermore, follow up transthoracic echocardiography showed that pericardial effusion was reduced, and follow up chest xray showed decreased pleural effusion fig. Eosinophilic pleural effusion in gnathostomiasis volume 10. Three cases of pleural effusion with eosinophilia are presented. Pleural fluid eosinophilia pfe, also called eosinophilic pleural effusion is defined as pleural fluid with a nucleated cell count containing more. Carbimazoleinduced eosinophilic pleural effusion bmj. Chronic eosinophilic pneumonia is a rare idiopathic interstitial lung disease. Eosinophilic pleural effusions epe are present in 710% of all unilateral pleural effusions, and are defined as a pleural eosinophil count 10% on cell diff.
We read with great interest the article by alagha et al. Churg strauss syndrome presenting as an eosinophilic. Cureus idiopathic eosinophilic pleural effusion treated. Chronic eosinophilic pneumonia in a 25yearold female with sustained symptoms on conventional treatment. A case of eosinophilic pleural effusion induced by. This demonstrated complete resolution of the pleural effusion. Pdf incidence and aetiology of eosinophilic pleural. Awareness of this rare adverse reaction of antithyroid drugs is important and methimazole can be added to the list of possible.
Various kinds of pleural effusion, depending on the nature of the fluid and what caused its entry into the pleural space, are hydrothorax serous fluid, hemothorax blood, urinothorax urine. Nayak, deepak m and belurkar, sushma v and srilatha, ps and shastry, indira and solanke, girish 20 churg strauss syndrome presenting as an eosinophilic pleural effusion. The temporal relationship between commencing carbimazole and developing a pleural effusion, along with the emergence of a peripheral eosinophilia after starting the drug are in keeping with this diagnosis. Incidence and aetiology of eosinophilic pleural effusion r. Supraclavicular lymph node biopsy was reported as amyloid. Although eosinophilic pleural effusion epe has been a subject of numerous studies, its clinical significance still remains unclear. In consideration of the frequency of pleural effusion in general, it is surprising that so few cases of pleural effusion with a large number of eosinophils have been reported in the literature. Eosinophilic pleural high activity as a systemic lupus. What is the role of pleural fluid eosinophilia in the. Eosinophilic pleural effusions are often benign but can be attributable to underlying malignancy in up to 10% of cases and therefore still needs to be investigated fully. Other biochemical parameters were within normal limits. Chronic eosinophilic pneumonia presenting with ipsilateral. However, eosinophilia is a relatively rare finding in malignant pleural effusions, and it has been used as an indicator of good prognosis. Hemorrhagic pleural effusion due to pleural hemangioma.
The prevalence and diagnostic significance of eosinophilic pleural. The naranjo score was calculated to be 7, indicating that the eosinophilic pleural effusion was. Comparison between the malignant and nonmalignant eosinophilic plural effusions. Iatrogenic pleural effusions are not rare but the diagnosis is mostly putative and difficult to ascertain. Their diagnostic and prognostic significance, however, remains controversial, as most of the studies are based almost entirely on retrospective case studies. The present study aimed to better characterize idiopathic epe iepe and to outline the diagnostic procedure for this disease. Eosinophilic pleural effusion as the first presentation of. International journal of science and research, 2 2. Jan 30, 2003 eosinophilic pleural effusions epfs, defined as the presence of 10% or more eosinophils in the pleural fluid, are relatively rare.
Eosinophilic exudative pleural effusion after initiation of. Incidence and aetiology of eosinophilic pleural effusion. Eosinophilic pleural effusions, defined as a pleural effusion that contains at least 10% eosinophils, may be caused by almost every condition that can cause. Eosinophilic pleural effusion epe is usually defined as a pleural effusion pe that contains. What is the role of pleural fluid eosinophilia in the workup. It is estimated that approximately 10 percent of exudative pleural effusions are eosinophilic 2,3,5. Review pleural effusion postgraduate medical journal. The causes of this finding are multiple, but, in the individual case or idiopathic occurrence, one should strongly consider the possibility of collagen disease.
We believe this is the first case reporting an eosinophilic exudative pleural effusion secondary to carbimazole. Pleural fluid eosinophilia pfe, with eosinophil values greater than 10% of nucleated cells, is seen in approximately 10% of pleural effusions and is not correlated with peripheral blood. Cytology revealed numerous eosinophils 91% with reactive mesothelial cells and no evidence of malignancy. Incidence and aetiology of eosinophilic pleural effusion european. Mesalamine was stopped and repeat cxr was obtained on the followup visit, which showed no pleural effusion. Despite the multitude of studies enumerating the causes of eosinophilic pleural effusion epe, 14%25% of such cases remain idiopathic even after thorough workup. Druginduced eosinophilic pleural effusion to the editors. Pleural effusion with eosinophilia journal of allergy. Echocardiography showed a small amount of pericardial effusion.
Chronic eosinophilic pneumonia presenting with ipsilateral pleural effusion. Diagnostic procedure for idiopathic eosinophilic pleural. These were modified by using bayes rule to estimate the revised probability of disease in the presence of an eosinophilic effusion. Carbimazoleinduced eosinophilic pleural effusion bmj case.
However, some patients remain idiopathic, even after thorough clinical workup. Pathogenesis of the eosinophilic pleural effusions. Eosinophilic pleural effusion and pericarditis with. Pleural effusion is commonly used as a catchall term to describe any abnormal accumulation of fluid in the pleural cavity. Eosinophilic pleural effusion epe has been associated with less risk for malignancy with a potential causal relationship with the presence of air. A pleural effusion is excess fluid that accumulates in the pleural cavity, the fluidfilled space that surrounds the lungs. The relative incidence of epe has been estimated at between 5% and 16% of all pes 1, 35, but the clinical significance of pleural fluid eosinophilia remains unclear. Hematological investigations revealed hemoglobin of 15.
Since, in our opinion, eosinophilic pleural effusion epe, and. Pleural fluid cytology showed exudative pleural effusion with eosinophilia. Comparison of age, sex and biochemical parameters in patients with eosinophilic and noneosinophilic pleural effusion. The pleural fluid should be evaluated for infection and malignant cells.
To the editors we read with great interest the article by a lagha et al. Eosinophilic pleural effusions epfs, defined as the presence of 10% or more eosinophils in the pleural fluid, are relatively rare. Moreover, eosinophilic infiltration was detected in duodenal and rectal biopsy samples that had been collected during endoscopic examination of the upper gastrointestinal. Secondly, eosinophilic pleural effusion is also unusual in gnathosthosmiasis. Eosinophilic pleural effusion epe has been associated with less risk for malignancy with a potential causal relationship with the presence of air andor blood in the pleural space. This excess fluid can impair breathing by limiting the expansion of the lungs. Six additional reports of eosinophilic pleural fluid in rheumatoid arthritis werelater published campbell and ferrington, 1968. Open access eosinophilic endomyocarditis combined with. In a patient like the one presented here, where the major causes of eosinophilic pleural effusion were excluded and the clinical picture didnt suggest the other minor causes, a drug reaction is worth considering.
Complete clinical data of 11 consecutive patients with iepe were prospectively collected and analysed. Since, in our opinion, eosinophilic pleural effusion epe, and druginduced epe in particular, is an interesting issue, we would like to add some comments to this article. Pleural fluid eosinophilia pfe, with eosinophil values greater than 10% of nucleated cells, is seen in approximately 10% of pleural effusions and is not. The present of an epe is not indicative of any particular diagnostic category malignancy vs non or particular diagnosis such as tb, for example.
We report a case of a 26yearold male who presented with shortness of breath. What is the role of pleural fluid eosinophilia in the workup for pleural. Following drainage of the pleural effusion via a chest drain, we performed repeat imaging of the chest. Eosinophilic pleural effusion occurs most commonly during conditions associated with the presence of blood or air in the pleural space, infections, and. Given that most effusions are detected by xray, which generally cannot distinguish between fluid types, the fluid in question maybe. Eosinophilic pleural effusions, defined as a pleural effusion that contains at least 10% eosinophils, may be caused by almost every condition that can cause pleural disease. Case report unusual presentation of chronic eosinophilic. Symptoms are dependent on the nature of the underlying disease and on the local effects of the fluid.
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