Abstract
A 43 year-old male had suffered from productive cough, fever, night sweating, body weight loss and malaise for two months before admission, when his peripheral blood showed marked eosinophilia and his chest X-ray film revealed “a photographic negative shadow of pulmonary edema” (Carrington et al., 1969). Later, the infiltration on the plain chest X-ray films extended to the central area, although the CT scan revealed that the infiltration on the left side did not involve the central area. Specimens taken by a transbronchial lung biopsy showed alveolar and interstitial eosinophilic infiltration with multinucleated giant cells. A slight degree of angiitis, but no granuloma was found. Results of respiratory function tests were normal except for a low threshold value for methacholine inhalation test (312ug/ml). Prednisolone (40mg per day) was begun and the clinical symptoms improved within a few days. The abnormal shadow on the chest X-ray film disappeared after one and a half months.
No causative drugs were elucidated. Examinations for bacteria, fungi and helminths were negative. As for the differential diagnosis, eosinophilic leukemia was denied by findings on specimens aspirated from the bone marrow. Tuberculosis was unlikely since cultures of the sputa were always negative. Sarcoidosis was denied by absence of hilar lymph node swellings and granuloma and by normal activity of angiotensin I converting enzyme. There were no signs of Hodgkin's disease. His disease was considered to be essentially the same as Carrington's “Chronic Eosinophilic Pneumonia”. The extension of the infiltration on the plain X-ray films to the central area was regarded as a peculiar finding of this case.
