ID: 40 yo female presents with 7 weeks of progressively worsening dyspnea and non-productive cough that have persisted despite a course of azithromycin. She was found to have diminished breath sounds bilaterally and a CBC with WBC of 20.3 and 43% eosinophils. She denied any recent travels, but admits to frequent “purification rundown” treatments with the Church of Scientology. She underwent a BAL that showed predominant eosinophils and a thoracentesis with 85% eosinophils. She was ultimately diagnosed with chronic eosinophilic pneumonia, thought to be secondary to her purification treatments (high doses of niacin). She was started on steroids with improvement in symptoms; however, each time she stopped steroid therapy and got more purification treatments, her symptoms would flare up.
The causes for peripheral eosinophilia can be broadly categorized into 2 mnemonics: CHINA or NAACP.
Pearls from morning report:
Purification rundown treatments were developed by the Church of Scientology founder L. Ron Hubbard. The goal goal was designed to remove LSD from the body using a restricted diet and large doses of vitamins.
Want to read more?
Eosinophilia (The New England Journal of Medicine)
Eosinophilic Lung Disease (Clinical Chest Medicine)
Weller PF, Klion AD, Mahoney DH, Bochner BS, Rosmarin AG, Feldweg AM. Approach to the patient with unexplained eosinophilia. In: UpToDate, Post TW (Ed), UpToDate, Waltham, MA. (Accessed on March 28, 2017)
Klion AD, Weller PF, Bochner BS, Hollingsworth H. Causes of pulmoanry eosinophilia. In: UpToDate, Post TW (Ed), UpToDate, Waltham, MA. (Accessed on March 28, 2017)