Eosinophilic pneumonia following occupational smoke exposure

A 21-year-old male patient with a history of occupational exposure to open fire smoke was initially treated with empiric antibiotics for simple community-acquired pneumonia. However, he continued to deteriorate rapidly, developed respiratory failure and needed mechanical ventilation. After possible aetiologies were considered, acute eosinophilic pneumonia was suspected and confirmed by broncho-alveolar lavage. His condition improved dramatically soon after glucocorticoid administration and he was discharged without sequelae. Acute eosinophilic pneumonia should be considered in a patient with a history of exposure to smoke presenting with pneumonia that deteriorates rapidly despite broad antibiotics. An important clue for the diagnosis is eosinophilia in peripheral blood.

Acute eosinophilic pneumonia (AEP) should be considered in any patient with pneumonia and peripheral blood eosinophilia.A detailed medical history, including exposure to cigarette or occupational smoke, is critical in all patients with pneumonia, especially in non-resolving cases.Once AEP is diagnosed, prompt glucocorticoid treatment usually leads to an immediate and dramatic response.