PDF(Pubmed)
Abstract：
Acute eosinophilic pneumonia (AEP) is a rare cause of acute respiratory failure. Clinical presentations can range from dyspnoea, fever and cough, to rapidly progressive and potentially fulminant respiratory failure. While its exact cause is often unknown, associations with inhalational injuries and exposures to new medications have been described.We report a case of a middle-aged, non-smoking man with a history of alcohol use disorder. He presented with 4 days of shortness of breath that started hours after taking injectable naltrexone (Vivitrol). The patient had rapidly worsening hypoxaemia, necessitating emergent bronchoscopy with transbronchial biopsies and bronchoalveolar lavage which showed 66% eosinophils. The patient was intubated for the procedure and unable to get extubated due to worsening hypoxaemic respiratory failure with high fractional inspired oxygen requirements. Chest radiograph showed worsening lung infiltrates and with a high index of suspicion for AEP, he was started empirically on methylprednisolone. He had rapid improvement in his respiratory status and was extubated on day 5 of admission then discharged on day 8. Histopathological examination confirmed acute/subacute eosinophilic pneumonia. A 3-week post-discharge follow-up chest radiograph confirmed the full resolution of pulmonary infiltrates.Naltrexone-induced AEP is rare, with only six other cases reported in the literature. Careful history taking and prompt evaluation for AEP are important given the potential for rapid progression to acute hypoxic respiratory failure and the excellent response to steroid treatment.
摘要：
急性嗜酸性粒细胞肺炎（AEP）是急性呼吸衰竭的罕见病因。临床表现可以从呼吸困难，发烧和咳嗽，快速进展和潜在的暴发性呼吸衰竭。虽然它的确切原因往往是未知的，已经描述了与吸入损伤和暴露于新药物的关联。我们报道了一个中年人的病例,有酒精使用障碍史的非吸烟男性。他在服用可注射的纳曲酮（Vivitrol）后数小时开始出现4天的呼吸急促。患者低氧血症迅速恶化，需要紧急支气管镜检查，经支气管活检和支气管肺泡灌洗，显示66％的嗜酸性粒细胞。由于低氧血症性呼吸衰竭恶化，对部分吸入氧气的需求较高，因此患者接受了插管，无法拔管。胸部X光片显示肺浸润恶化，对AEP的怀疑程度很高，他开始对甲基强的松龙进行经验性治疗.他的呼吸状态迅速改善，并在入院第5天拔管，然后在第8天出院。组织病理学检查证实急性/亚急性嗜酸性粒细胞肺炎。出院后3周的胸部X光片证实了肺浸润的完全消退。纳曲酮诱导的AEP很少见，文献中只报道了6例其他病例。考虑到快速发展为急性低氧性呼吸衰竭的潜力以及对类固醇治疗的良好反应，仔细的病史记录和对AEP的及时评估非常重要。
