Drug-Induced Pulmonary Eosinophilia

Etiology

Anti-Androgenic Agents

Antibiotics

Cephalosporins (see Cephalosporins)

Fluoroquinolones (see Fluoroquinolones)

Macrolides (see Macrolides)

  • Azithromycin (Zithromax) (see Azithromycin)
  • Clarithromycin (Biaxin) (see Clarithromycin)
  • Erythromycin (see Erythromycin)
  • Roxithromycin (Biaxsig, Coroxin, Romac, Roxar, Roximycin, Roxl-150, Roxo, Roxomycin, Rulid, Rulide, Surlid, Tirabicin, Xthrocin) (see Roxithromycin)

Penicillins (see Penicillins)

Sulfonamides (see Sulfonamides)

Tetracyclines (see Tetracyclines)

Other Antibiotics

Anticonvulsants

Anti-Hyperlipidemic Agents

Antihypertensives

Anti-Inflammatory Agents

Chemotherapeutic Agents

Hypoglycemic Agents

Non-Steroidal Anti-Inflammatory Drug (NSAID) (see Non-Steroidal Anti-Inflammatory Drug])

Psychiatric Drugs

Other


Physiology

  • Possible Immune Complex Mechanism

Diagnosis

  • Sputum Culture: negative
  • CXR/Chest CT Patterns:
    • Diffuse Alveolar Infiltrates:
    • Pleural Effusion: seen only in Nitrofurantoin-associated cases
  • Pulmonary Function Tests (PFT’s): decreased DLCO is seen in all cases (but reversible obstruction or restriction were not observed)
  • CBC: eosinophilia
    • Nitrofurantoin acute-type syndrome usually has the highest degree of eosinophilia (as compared to subacute and chronic-type syndromes)

Clinical Manifestations

General Comments

  • Onset: symptoms usually occur within hours-days after starting drug
  • Asymptomatic Cases: some cases may be asymptomatic

Pulmonary Manifestations

  • Crackles: 66% of cases
  • Dry Cough (see Cough): variable
  • Dyspnea (see Dyspnea)
  • Wheezing: variable
    • However, reversible airway obstruction is not seen

Other Manifestations

  • Low-Grade Fever (see Fever)

Drug Rash with Eosinophilia and Systemic Symptoms (DRESS Syndrome) (see Drug Rash with Eosinophilia and Systemic Symptoms)

Associated Agents

Clinical Manifestations

  • Cardiovascular Manifestations 15% of cases)
  • Dermatologic Manifestations
  • Gastrointestinal Manifestations
  • Pulmonary Manifestations
    • Pneumonitis (see Pneumonia): in 33% of cases
  • Renal Manifestations: 40% of cases
  • Rheumatologic/Orthopedic Manifestations
  • Other Manifestations
    • Fever (see Fever)
    • Lymphadenopathy (see Lymphadenopathy)
    • Pseudolymphoma Syndrome: lymphadenopathy and abnormal circulating lymphocytes may especially occur in anticonvulsant-associated cases

Treatment

  • Drug Withdrawal: spontaneous resolution, infiltrates and symptoms usually resolve
    • Does not tend to resolve as fast as Loffler’s though
  • Corticosteroids (see Corticosteroids): may or may not be useful in some cases with slow resolution

References

  • Ann Pharmacother 41:696-701 (2007); J Infection 54:e211-e213 (2007)