A Previously Healthy 37-Year-Old Man With Acute Hypoxic Respiratory Failure and Fevers
Copyright © 2020 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved..
CASE PRESENTATION: A previously healthy 37-year-old man initially presented to a hospital near his home with persistent cough after failing outpatient azithromycin for empiric treatment of pneumonia. He was newly employed as a bulldozer operator burying trash in a landfill in Virginia, which he continued throughout his illness. He owned two healthy dogs, had never traveled outside the state, and denied a history of cigarette smoking, alcohol, and substance use. His WBC count was 13.4 × 109/L (11% eosinophils). CT scan of the chest showed ground glass opacities. Subsequent bronchoscopy with BAL of the right middle lobe showed eosinophilic predominance (46%); transbronchial biopsy of right lower lobe was performed. Infectious and autoimmune work up that was negative included blood, urine, and BAL cultures, BAL Pneumocystis pneumonia direct immunofluorescence assay, urine legionella antigen, serum HIV antibody, antinuclear antibodies, anti-neutrophil cytoplasmic antibodies, and angiotensin converting enzyme. After improvement in hypoxia with inpatient corticosteroid therapy, he was discharged home with a two week course of prednisone for a presumptive diagnosis of acute eosinophilic pneumonia. He subsequently experienced worsening fever and difficulty breathing; six weeks after his symptoms began, he was admitted to our hospital.
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| Medienart: |
E-Artikel |
| Erscheinungsjahr: |
2020 |
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| Erschienen: |
2020 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:158 |
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| Enthalten in: |
Chest - 158(2020), 4 vom: 06. Okt., Seite e169-e174 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Axell-House, Dierdre B [VerfasserIn] |
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Date Completed 27.05.2021 Date Revised 02.04.2024 published: Print CommentIn: Chest. 2021 May;159(5):2106. - PMID 33965132 Citation Status MEDLINE |
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| doi: |
10.1016/j.chest.2020.05.544 |
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NLM316060658 |
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| 520 | |a Copyright © 2020 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved. | ||
| 520 | |a CASE PRESENTATION: A previously healthy 37-year-old man initially presented to a hospital near his home with persistent cough after failing outpatient azithromycin for empiric treatment of pneumonia. He was newly employed as a bulldozer operator burying trash in a landfill in Virginia, which he continued throughout his illness. He owned two healthy dogs, had never traveled outside the state, and denied a history of cigarette smoking, alcohol, and substance use. His WBC count was 13.4 × 109/L (11% eosinophils). CT scan of the chest showed ground glass opacities. Subsequent bronchoscopy with BAL of the right middle lobe showed eosinophilic predominance (46%); transbronchial biopsy of right lower lobe was performed. Infectious and autoimmune work up that was negative included blood, urine, and BAL cultures, BAL Pneumocystis pneumonia direct immunofluorescence assay, urine legionella antigen, serum HIV antibody, antinuclear antibodies, anti-neutrophil cytoplasmic antibodies, and angiotensin converting enzyme. After improvement in hypoxia with inpatient corticosteroid therapy, he was discharged home with a two week course of prednisone for a presumptive diagnosis of acute eosinophilic pneumonia. He subsequently experienced worsening fever and difficulty breathing; six weeks after his symptoms began, he was admitted to our hospital | ||
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