NEJM Incidence and aetiology of eosinophilic pleural effusion. Eur Respir J ; — Chest Diagnostic utility of eosinophils in the pleural fluid. Eur Res J. Probability of malignancy in pleural fluid eosinophilia. Therapy-induced Toxicity of the Lungs: An Overview. However, our patient had a normal trans-thoracic echocardiography and beta natriuretic peptide. In addition, the pleural effusion of the three previously reported patients resolved rapidly with clinical improvement, using treatment recommendations for HES of normalizing the peripheral eosinophilia [ 5 — 7 ].
Despite rapid reduction of the peripheral eosinophilia in our patient, the eosinophilic pleural effusion continued to accumulate for months questioning this therapeutic recommendation.
A recent review of patients with EPE reported 2 out of patients with percentage of eosinophils in peripheral blood higher than in pleural fluid. Those two patients had hematological malignancies [ 1 ]. Our patient had features of both the myeloproliferative and the lymphocytic variants of HES. There are several chemotherapy choices depending on the variant of HES and new drugs are in clinical trials [ 3 ].
Our patient expired prior to receiving alternate treatment; however, it should be noted that the recommendation of titrating these therapies as well is normalization of the peripheral eosinophilia which had already been obtained in our patient but without clinical benefit. Treatment of eosinophilic pleural effusions is directed toward the underlying cause, in this case hypereosinophilic syndrome. Disease remission cannot be determined by resolution of peripheral eosinophilia alone but also by the absence of recurrence or progression of end-organ damage [ 8 ].
Okafor et al. This is an open access article distributed under the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Article of the Year Award: Outstanding research contributions of , as selected by our Chief Editors. Read the winning articles. Journal overview. Okafor , 1 Ayodeji A. Oso, 1 Amanke C. Oranu, 1 Steven M. Wolff, 1 and John J. Academic Editor: Stephen P.
Received 26 Aug Accepted 05 Nov Published 12 Jan Abstract Several causes of eosinophilic pleural effusions have been described with malignancy being the commonest cause.
Case Presentation year-old African American male presented with shortness of breath of over two months. Figure 1. Chest radiography and CT scan of the chest showing bilateral pleural effusions. Table 1. Pleural fluid PF analysis at monthly intervals. Case summary: A year-old white woman was admitted to the hospital because of chest pain and dyspnea related to pleurisy and a pericardial tamponade.
This patient had no history of allergy and had been taking vitamins B5 and H for two months. Pleurocentesis and pericardiotomy yielded a sterile exudative fluid with an eosinophilic infiltrate.
There were no nuclear antibodies and no rheumatic factor; screenings for viruses, parasites, bacteria, and malignant tumor were negative. A myelogram, biopsy of the iliac crest bone, and concentration of immunoglobulin E were also normal.
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