30 Jun 2022

3/28/17 Resident Morning Report – Eosinophilia, Eosinophilic Pneumonia

CC: dyspnea

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.

Don’t forget:

The causes for peripheral eosinophilia can be broadly categorized into 2 mnemonics: CHINA or NAACP.

  • C – connective tissue disease
  • H – helminthic disease
  • I – idiopathic/iatrogenic
  • N – neoplastic
  • A – allergic/asthma
  • N – neoplastic
  • A – allergic
  • A – asthma/atopic
  • C – connective tissue disease
  • P – parasites

Pearls from morning report:

  • An absolute eosinophil count (AEC) > 20,000 should raise suspicion for malignancy.
  • Bacterial infections very rarely cause eosinophilia.
  • > 25% eosinophils on BAL is suggestive of a diagnosis of acute eosinophilic pneumonia, and > 40% for chronic eosinophilic pneumonia.
  • Chronic eosinophilic pneumonia may appear on CXR as ‘photographic negative of pulmonary edema’ and is considered pathognomonic for the disease.

Random trivia:

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)

Leave a Reply

This site uses Akismet to reduce spam. Learn how your comment data is processed.