A Woman with Asthma and Peripheral Ground-Glass Opacities

Eosinophilic lung disease is a heterogeneous group of disorders that reveal eosinophil involved lung tissue often in patients with asthma or atopy. Classification and diagnostic criteria of eosinophilic lung disease are not well-established; however, peripheral ground-glass opacity is typical on chest computed tomography. Another etiology of this same radiographic finding reported in the literature is silicone embolism syndrome. Here, we present a 43-year-old female with poorly controlled severe persistent asthma presenting with difficulty breathing. Computed tomography showed peripherally dominant ground-glass opacity. Peripheral blood, bronchoalveolar lavage fluid analysis, and transbronchial biopsy did not find eosinophilia. Serial bronchoalveolar lavage of the demonstrated increasingly blood-tinged fluid. The patient required mechanical ventilation upon admission. After further questioning the patient revealed that she had frequently received injectable cosmetics at non-licensed establishments. Initially, due to past medical history, presentation, and radiographic findings, eosinophilic pneumonia was suspected. However, after a review of the patient's social history and risk factors, silicone embolisms syndrome became a likely diagnosis. The patient had good clinical response to high dose steroid therapy.