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Chronic eosinophilic pneumonia (CEP) is a rare disease of unknown cause characterized by alveolar and interstitial eosinophilic infiltration. The tomographic pattern is characterized by consolidations and peripherally distributed ground glass opacities in both upper lobes. Other findings are opacities in bands parallel to the pleura, thickening of the interlobular septa, migratory opacities, and mediastinal lymph nodes. We presented a case of a woman with CEP and described the most relevant clinical and radiological characteristics.

La neumonía eosinofílica crónica (NEC) es una enfermedad rara de causa desconocida caracterizada por infiltración eosinofílica alveolar e intersticial. El patrón tomográfico se caracteriza por consolidaciones y opacidades en vidrio esmerilado de distribución periférica en ambos lóbulos superiores. Otros hallazgos son las opacidades en bandas paralelas a la pleura, engrosamiento de septos interlobulillares, opacidades migratrices y adenomegalias mediastinales. Se presenta el caso de una mujer con NEC y se describen las características clínicas y radiológicas más relevantes.

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Chest imaging is often used as a complementary tool in the evaluation of coronavirus disease 2019 (COVID-19) patients, helping physicians to augment their clinical suspicion. Despite not being diagnostic for COVID-19, chest CT may help clinicians to isolate high suspicion patients with suggestive imaging findings. However, COVID-19 findings on CT are also common to other pulmonary infections and non-infectious diseases, and radiologists and point-of-care physicians should be aware of possible mimickers. This state-of-the-art review goal is to summarize and illustrate possible etiologies that may have a similar pattern on chest CT as COVID-19. The review encompasses both infectious etiologies, such as non-COVID viral pneumonia, Mycoplasma pneumoniae, Pneumocystis jiroveci, and pulmonary granulomatous infectious, and non-infectious disorders, such as pulmonary embolism, fat embolism, cryptogenic organizing pneumonia, non-specific interstitial pneumonia, desquamative interstitial pneumonia, and acute and chronic eosinophilic pneumonia.

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INTRODUCCIÓN: La Neumonía Eosinofílica (NE) es una entidad muy poco frecuente en pediatría y se caracteriza por infiltración de eosinófilos en el intersticio pulmonar y alveolar, pudiendo ser primaria o secundaria, así como también presentar un curso agudo o crónico. OBJETIVO: Presentar dos casos clínicos de NE diagnosticados en el período 2014-2017 en una Unidad de Cuidados Intensivos pediátricos. CASOS CLÍNICOS: Dos lactantes mayores, ambos con antecedente de madre asmática, hospitalizados por in suficiencia respiratoria y diagnóstico de neumonía viral en Clínica Indisa, Santiago, Chile. Ambos presentaron síndrome febril, imágenes de condensación persistentes en la radiografía de tórax y eosinofilia periférica en el transcurso de su enfermedad. Uno de ellos con requerimiento de oxígeno por más de un mes, sin eosinofilia en el lavado broncoalveolar (LBA), al que se le hizo el diagnóstico de NE por biopsia pulmonar. El otro niño requirió ventilación mecánica por 28 días y se hizo diag nóstico de NE por eosinofilia mayor a 20% en LBA. Los dos casos presentaron excelente respuesta a corticoides sistémicos. CONCLUSIÓN: La NE se debe sospechar en el niño con diagnóstico de neumonía con síntomas persistentes sin respuesta al tratamiento, habiéndose descartado otras causas, sobre todo si se asocia a eosinofilia periférica. El diagnostico de NE en pediatría se confirma por eosinofilia mayor a 20% en LBA y en algunos casos es necesaria la biopsia pulmonar.

INTRODUCTION: Eosinophilic Pneumonia (EP) is a very rare disorder in Pediatrics. It is characterized by the infiltra tion of eosinophils in the pulmonary and alveolar interstitium, and may be primary or secondary as well as present an acute or chronic progress. OBJECTIVE: to present 2 pediatric EP clinical cases which were diagnosed at the pediatric intensive care unit of Clinica Indisa in Santiago, Chile between 2014 and 2017. CLINICAL CASES: Two older infants, who were hospitalized due to respiratory failure with a diagnosis of viral pneumonia. Both have asthmatic mothers. Additionally, they both had febrile syn drome, persistent condensation images in the chest x-rays, and peripheral eosinophilia throughout the course of the disease. One of the infants required oxygen for more than one month, and there was no eosinophilia in the bronchoalveolar lavage (BAL). In this case, the diagnosis of EP was reached via pulmonary biopsy. The other infant required mechanic ventilation for 28 days, and was diagnosed due to eosinophilia greater than 25% in the bronchoalveolar lavage. Both patients had excellent res ponse to systemic corticosteroids. CONCLUSION: After ruling out other causes, EP should be suspected in children with pneumonia diagnosis, and persistent symptoms that do not respond positively to treatment, especially if associated with peripheral eosinophilia. The diagnosis of EP in pediatrics is confirmed with eosinophilia greater than 20% in BAL and, in some cases, it is necessary to perform a lung biopsy.

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INTRODUCTION: Eosinophilic Pneumonia (EP) is a very rare disorder in Pediatrics. It is characterized by the infiltra tion of eosinophils in the pulmonary and alveolar interstitium, and may be primary or secondary as well as present an acute or chronic progress. OBJECTIVE: to present 2 pediatric EP clinical cases which were diagnosed at the pediatric intensive care unit of Clinica Indisa in Santiago, Chile between 2014 and 2017. CLINICAL CASES: Two older infants, who were hospitalized due to respiratory failure with a diagnosis of viral pneumonia. Both have asthmatic mothers. Additionally, they both had febrile syn drome, persistent condensation images in the chest x-rays, and peripheral eosinophilia throughout the course of the disease. One of the infants required oxygen for more than one month, and there was no eosinophilia in the bronchoalveolar lavage (BAL). In this case, the diagnosis of EP was reached via pulmonary biopsy. The other infant required mechanic ventilation for 28 days, and was diagnosed due to eosinophilia greater than 25% in the bronchoalveolar lavage. Both patients had excellent res ponse to systemic corticosteroids. CONCLUSION: After ruling out other causes, EP should be suspected in children with pneumonia diagnosis, and persistent symptoms that do not respond positively to treatment, especially if associated with peripheral eosinophilia. The diagnosis of EP in pediatrics is confirmed with eosinophilia greater than 20% in BAL and, in some cases, it is necessary to perform a lung biopsy.

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Background: The eosinophilic bronchopneumopathy (EBP) is characterized by pulmonary infiltration with eosinophils. The etiology of canine EBP remains unclear, although hypersensitivity to aeroallergens is suspected. Dogs affected are usually young. The persistent cough is the most common clinical sign, often associated with respiratory difficulty and exercise intolerance. The diagnosis is based on signalment, radiographic and bronchoscopic findings, and the tissue eosiphilic infiltration demonstrated by cytology of bronchoalveolar lavage (BAL). No reports were found in Brazil. The aim of this paper is report four cases of canine BPE, with emphasis on clinical aspects, diagnosis and therapy.Cases: Case 1. A 18-month-old female dog with 12 kg of body weight was presented for consultation with a 60-day history of cough, inappetence and weariness. It presented cough and tachypnea. The complementary exams demonstrated peripheral eosinophilia, bronchointersticial pulmonary pattern on radiography, moderate amount of mucus on bronchoscopy and tissue eosinophilis infiltration on the BAL. The treatment was based on steroids, with improvement of clinical signs. Case 2. A 24-month-old female dog with 16 kg of body weight was presented for consultation with one-year history of cough, inappetence and lethargy. It presented only cough, and in complementary exams showed transitory peripheral eosinophilia, bronchointersticial pattern on radiography and predominantly eosinophilic inflammation on citology of BAL. The therapy was based on steroids, with improvement followed by worsening of signs, with need of readjustment of doses. Case 3. A 8-year-old male dog with 6.2 kg of body weight was presented for consultation with 3-weeks history of productive cough, vomiting and weight loss. The complementary exams showed peripheral eosinophilia, bronchointersticial pulmonary pattern on radiography and eosinophils infiltration on cytology of BAL.[...]

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Background: The eosinophilic bronchopneumopathy (EBP) is characterized by pulmonary infiltration with eosinophils. The etiology of canine EBP remains unclear, although hypersensitivity to aeroallergens is suspected. Dogs affected are usually young. The persistent cough is the most common clinical sign, often associated with respiratory difficulty and exercise intolerance. The diagnosis is based on signalment, radiographic and bronchoscopic findings, and the tissue eosiphilic infiltration demonstrated by cytology of bronchoalveolar lavage (BAL). No reports were found in Brazil. The aim of this paper is report four cases of canine BPE, with emphasis on clinical aspects, diagnosis and therapy.Cases: Case 1. A 18-month-old female dog with 12 kg of body weight was presented for consultation with a 60-day history of cough, inappetence and weariness. It presented cough and tachypnea. The complementary exams demonstrated peripheral eosinophilia, bronchointersticial pulmonary pattern on radiography, moderate amount of mucus on bronchoscopy and tissue eosinophilis infiltration on the BAL. The treatment was based on steroids, with improvement of clinical signs. Case 2. A 24-month-old female dog with 16 kg of body weight was presented for consultation with one-year history of cough, inappetence and lethargy. It presented only cough, and in complementary exams showed transitory peripheral eosinophilia, bronchointersticial pattern on radiography and predominantly eosinophilic inflammation on citology of BAL. The therapy was based on steroids, with improvement followed by worsening of signs, with need of readjustment of doses. Case 3. A 8-year-old male dog with 6.2 kg of body weight was presented for consultation with 3-weeks history of productive cough, vomiting and weight loss. The complementary exams showed peripheral eosinophilia, bronchointersticial pulmonary pattern on radiography and eosinophils infiltration on cytology of BAL.[...](AU)

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The diagnosis of eosinophilic pneumonia (EP) is rare and challenging. This condition is frequently misdiagnosed as pulmonary tuberculosis, lymphoma, schistosomiasis, Wegener's granuloma, severe acute respiratory syndrome, or severe community-acquired pneumonia. Herein, we report a case in which computed tomography (CT)-guided percutaneous lung biopsy was used to diagnose EP without alveolar eosinophilia or peripheral eosinophilia. A roundworm identified in the patient's stool confirmed the precise diagnosis to be parasitic EP. This is, to our knowledge, the first reported case of EP confirmed by CT-guided percutaneous lung biopsy. CT-guided percutaneous lung biopsy may represent a new tool for the diagnosis of EP in patients without typical alveolar eosinophilia or peripheral eosinophilia.

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Chronic eosinophilic pneumonia. The chronic eosinophilic pneumonia is part of Pulmonary Eosinophilic Syndroms. It is presented a 33-years old man, Asmathic, with dry cough, fever, night sweats and fatigue of several weeks. The chest X-ray showed opacity in the right hemithorax. He was treated with antibiotics without response. A chest TC showed multifocal involvement. The patient refused bronchoalveolar lavage (BAL) so treatment antituberculostatic was started. Despite treatment the symptoms worsened. The Chest X-ray showed migration of the infiltrates and the blood smear marked eosinophilia. Finally, bronchoalveolar lavage was carried out and it showed a high percentage of eosinophils (over 50%). The patient was treated with inmmunosuppresive doses of corticosteroids with excellent response. The blood smear in Nonresolving pneumonia is key to consider eosinophilic pneumonia, an uncommon pathology but amenable to treatment.

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The authors report the case of a female patient who developed chronic eosinophilic pneumonia secondary to long-term use of nitrofurantoin for prophylaxis of recurrent urinary tract infections due to urethral stenosis. On high-resolution computed tomography scans, the pulmonary reaction to nitrofurantoin most commonly manifests as an interstitial-alveolar pattern in both lung bases. However, in this case, the alterations were most pronounced in the periphery of the upper lobes. In itself, this tomographic profile is strongly indicative of chronic eosinophilic pneumonia. The patient had previously been submitted to an open lung biopsy. The diagnosis of chronic eosinophilic pneumonia was confirmed through a review of the biopsy.

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Propósito. Evaluar la utilidad de la tomografía computada en el diagnóstico de la neumonía eosinofílica crónica. Material y métodos. Se efectuó tomografía computada doble helicoidal en 6 pacientes remitidos a nuestro centro por presentar una radiografía de tórax con infiltrados pulmonares, un cuadro clínico consistente en tos seca y fiebre y eosinofilia en sangre periférica. La edad de los pacientes oscilaba entre 25 y 55 años e incluían 4 mujeres y 2 varones, uno de los cuales presentaba antecedentes de asma bronquial. Todos los pacientes recibieron tratamiento con corticoesteroides, remitiendo el cuadro clínico y radiológico en todos los casos. Se realizó tomografía de control en 3 pacientes. Resultados. Los hallazgos consistieron en alteraciones parenquimatosas focales, con zonas de consolidación pulmonar y áreas en vidrio esmerilado, coexistiendo ambos patrones en determinadas áreas. Estas alteraciones comprometían fundamentalmente el manto. En 3 casos se extendían de vértices a bases pulmonares, con predominio en campos superiores y medios. En 1 paciente el predominio en la extensión era franco en hemitórax izquierdo. En el restante, quien presentaba antecedentes de asma bronquial, se encontraron signos de hiperinsuflación, con engrosamiento difuso de las paredes bronquiales además de los hallazgos mencionados que comprometían todo el pulmón. A nivel mediastinal, 1 paciente presentaba ganglios mayores a 1 cm, 3 presentaban ganglios en rango no adenomegálico pero en número mayor al habitual y en los restantes no se observaron ganglios linfáticos. En las tomografías de control realizadas se observó resolución casi total de los infiltrados pulmonares. Conclusión. En nuestra opoinión, la combinación de eosinofilia sanguínea e infiltrados pulmonares característicos en un marco clínico sugestivo, asociado a una respuesta óptima al tratamiento con corticoides, es suficiente para efectuar un diagnóstico confiable y evitar la realización de una biopsia pulmonar (AU)

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Las enfermedades pulmonares eosinofílicas constituyen un variado grupo de patologías que tienen en común la presencia de eosinofilia periférica y tisular e infiltrados radiológicos. Dentro de este grupo se encuentran las neumonías eosinofílicas crónicas. Presentamos dos casos de esta patología en los cuales la biopsia pulmonar no fue necesaria para su diagnóstico. Ambos casos de sexo masculino consultan por síndrome febril y tos, con eosinofilia periférica y eritrosedimentación elevada. En la radiografía y tomografía computada de tórax se observan infiltrados intersticioalveolares periféricos y bilaterales. Examen parasitológico normal. El lavado bronquioalveolar es negativo para células neoplásicas, gérmenes comunes, micológico y tuberculosis, con aumento de Eosinófilos en el mismo. Presentan mejoría clínica y radiológica al tratamiento con corticoides. Actualmente es posible diagnosticar esta patología en base a la presentación clínica típica, los infiltrados radiológicos característicos, el aumento de porcentajes de Eosinófilos en el lavado bronquioalveolar y la rápida respuesta al tratamiento con corticoides, reservando la biopsia pulmonar para casos más dificultosos. (AU)

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A 37 year old female smoker was admitted with an acute episode of fever and pulmonary infiltrates followed by respiratory failure requiring mechanical ventilation in less than 24 hours. After empiric antibiotic therapy fiberoptic bronchoscopy and bronchoalveolar lavage (BAL) were carried out. Abnormal findings were limited to highly increased eosinophilic count in BAL. Blood eosinophils were normal. Acute eosinophilic pneumonia was diagnosed and methyl prednisolone was administered; 48 hours afterwards, infiltrates had partially resolved and the patient was weaned from ventilator. After two years follow up, she has not had recurrences of the episode, is asymptomatic and her chest Xray is normal. A review of the literature is presented and physiopathological mechanisms for acute eosinophilic pneumonia are considered. Acute eosinophilic pneumonia is a rare but potentially curable cause of respiratory failure that should be included in diagnostic considerations.

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Se comunica un caso de enfermedad febril aguda en una mujer de 37 años, fumadora, con infiltrados pulmonares difusos, que evolucionó a insuficiencia respiratoria en 24 hs con necesidad de intubación cuyo único hallazgo positivo fue eosinofilia marcada en el lavado broncoalveolar, sin eosinofilia en sangre periférica. Se diagnosticó Neumonía Eosinfílica Aguda. El tratamiento con metil prednisolona permitió la extubación al segundo día, con mejoría clínica y remisión parcial de los infiltrados radiólogicos. No hubo recurrencia del cuadro en los 2 años posteriores. Describimos este caso de neumonía eosinofilica aguda porque creemos importante su inclusión como diagnóstico diferencial entre las múltiples causas de insuficiencia respiratoria aguda, ya que es una patología potencialmente curable. Se realiza revisión de la literatura, se analizó posibles causas desencadenantes y mecanismos fisiopatogénicos. (Au)

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Se presenta un caso de una paciente de 49 años de edad, sexo femenino, con diagnóstico de neumonía eosinifílica crónica asociada con asma. Se describen las características clínicas, radiológicas y de laboratorio. Presenta antecedentes familiares alérgicos, una historia aprevia de rinitis perenne y asma bronquial de larga evolución. El diagnóstico de este paciente se realizó teniendo en cuenta: 1) el cuadro clínico; 2) la hipereosinofilia periférica, y 3) el infiltrado pulmonar característico. Además se consideró la respuesta espectacular al tratamiento corticoideo, con desaparición de los síntomas clínicos y radiológicos con cinco días de tratamiento

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