Abstract
A 22-year-old man was admitted to the hospital because of an open fracture in the left thumb following a motorcycle accident. He developed a fever, dyspnea, a dry cough, and hypoxia 15 days after admission. His past history and the clinical course of the fracture were unremarkable, except that he started smoking suddenly and heavily 3 days after admission. After methylprednisolone 1, 000mg was administered intravenously, he was transferred to the ICU of our hospital. At the time of transfer, his temperature was 37.8°C, his respiratory rate was 72min-1, and his heart rate was 136min-1. He exhibited marked respiratory distress. He had diffuse crackles on both lungs. His chest X-rays demonstrated both bilateral interstitial and alveolar infiltrates. An echocardiogram showed normal cardiac function and pleural effusion in the right lung. Arterial blood gases while breathing 100% oxygen by mask were as follows: pH 7.41, PaO2 78mmHg, PaCO2 38mmHg, BE 0.5mmol·l-1. His peripheral white blood cell count was 14, 000mm-3, with 2% band forms, 93% segmented neutrophils, 2% lymphocytes, 1% monocytes, and 2% eosinophils. We started treating him with supplemental oxygen and intravenous imipenem/cilastatin, minocycline, and gamma-globulin. Subsequent laboratory data revealed negative HIV antibody, negative ATLA antibody, and positive Candidal antigen. He developed blood eosinophilia (44%) and recovered from acute hypoxic respiratory failure without complication 8 days after admission to the ICU. We diagnosed his illness as acute eosinophilic pneumonia (AEP). We suspected that AEP was induced by sudden and heavy cigarette smoking.
