A case of eosinophilic pneumonia successfully treated with suplatast tosilate alone

We report a case of eosinophilic pneumonia that was successfully treated with suplatast tosilate. A 72-year-old woman with hypertension and diabetes, who did not smoke and did not have pets, consulted a physician with the chief complaints of cough, sputum, and slight fever. Chest X-ray films revealed a permeation shadow in the bilateral upper lobes. She visited a hospital because her symptoms did not improve. Pulmonary tuberculosis was suspected because of an elevated inflammatory reaction, and anti-tuberculosis treatment was started. Afterwards, eosinophilia appeared in the peripheral blood. Although daily drugs (nicardipine hydrochloride, pentoxifylline, and ticlopidine hydrochloride) were stopped, eosinophilia did not improve and was detected in a sputum sample. She was diagnosed with pulmonary infiltration with eosinophilia syndrome and hospitalized. Physical examination revealed neither rhonchus nor cardiac murmurs on auscultation. Laboratory findings showed a leukocyte count of 21,300/microl, with eosinophils accounting for 66.3% of cells. A diagnosis of eosinophilic pneumonia was made after a lung biopsy specimen was examined under a bronchial fiberscope. After suspension of anti-tuberculosis drugs and administration of suplatast tosilate 300 mg/day for 4 weeks, symptoms subsided, eosinophilia improved to within normal ranges, eosinophils in sputum disappeared, and the permeation shadow disappeared on chest X-ray films.