Acute eosinophilic pneumonia after recent start of smoking

• Published in: The Lancet (British edition) Vol. 385; no. 9973; p. 1150
• Main Authors: Brackel, Caroline L H, Dr, Ropers, Fabienne G, MD, Vermaas-Fricot, Sophie F N, MD, Koens, Lianne, MD, Willems, Luuk N A, PhD, Rikkers-Mutsaerts, Eleonora R V M, MD
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 21-03-2015; Elsevier Limited
• Subjects: Acute Disease; Adolescent; Antibiotics; Female; Humans; Internal Medicine; Medical diagnosis; Medical treatment; Pneumonia; Pulmonary Eosinophilia - etiology; Smoking; Smoking - adverse effects
• ISSN: 0140-6736; 1474-547X
• DOI: 10.1016/S0140-6736(15)60128-3

Repeat chest radiograph showed progressive bilateral infiltrations and a right-sided pleural effusion, but unexpectedly C-reactive protein had decreased from 92 mg/L to 32 mg/L. Because our patient had a pneumonia that was not resolving with standard antibiotic treatment we widened our differential diagnosis to include antimicrobial failure due to resistant or unusual micro-organisms (such as legionella), infectious complications (such as Staphylococcus aureus empyema), and noninfectious causes such as chemical pneumonitis, eosinophilic pneumonia, vasculitis, or diffuse lung disease.1 We changed the antibiotics to flucloxacillin and ciprofloxacin.