Difficult-to-treat asthma with idiopathic chronic eosinophilic pneumonia

As known, idiopathic chronic eosinophilic pneumonia (ICEP) is a rare disorder of unknown etiology characterized by subacute or chronic respiratory and general symptoms, alveolar and/or blood eosinophilia, and peripheral pulmonary infiltrates on chest imaging.

According to Norbert Pauk, MD, PhD, Charles University,  Faculty Hospital Na Bulovce, Prague, Czech Republic, ICEP is a rare complication of asthma, one seldom mentioned in reviews and textbooks on asthma.  Asthma in patients with ICEP is relatively severe and get worse after ICEP diagnosis.

He presented the case of a 70-year-old woman with a history of asthma and chronic rhinitis with polyps (diagnosed in  2003). She was a  nonsmoker with no history of allergies but frequent exacerbations of asthma (seven times a year with repeated courses of oral corticosteroids). In 2006 she had sudden fever, weight loss, malaise, and impaired dyspnea  with productive cough, mild chest pain on the sternum, and respiratory failure.  A chest radiograph demonstrated bibasilar infiltrates. Peripheral blood smear showed a newly developed, marked eosinophilia; chest x-rays and HRCT scan revealed a diffuse patchy nodular infiltrate in all lung fields. Serum-precipitating antibodies against aspergillus antigens were negative and there was no cutaneous reactivity to aspergillus antigen. Likewise there were negative findings for parasitic infections, no central bronchiectasis on previous HRCT; and ANCA, ANA, and ENA were negative.