309 Difficult-to-treat Asthma with Idiopathic Chronic Eosinophilic Pneumonia

BACKGROUND: Idiopathic chronic eosinophilic pneumonia (ICEP) is a rare disorder of unknown cause characterised by subacute or chronic respiratory and general symptoms, alveolar and /or blood eosinophilia, and peripheral pulmonary infiltrates on chest imaging. Interestingly, some but not all patients diagnosed with ICEP have a history of asthma, whilst others may develop asthma after a dignosis of ICEP has been made. METHODS: We present this rare and interesting case, because ICEP is a rare complication of asthma, although it is seldom mentioned in reviews ant textbooks on asthma. Asthma in patients with ICEP is relatively severe and get worse after diagnosis of ICEP. RESULTS: A 70-year-old woman with a history of asthma and chronic rhinitis with polyps (diagnosed in 2003), nonsmoker, history of allergies negative. She suffered from frequent exacerbations of asthma (7 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 sternum and respiratory failure. A chest radiograph demonstrated bibasilar infiltrates. Peripheral blood smear showed a newly developed, marked eosinophilia, and a chest X-rays and HRCT scan revealed a diffuse patchy nodular infiltrate in all lung fields. Serum-precipitating antibodies against Aspergillus antigens negative, no cutaneous reactivity to Aspergillus antigen, negative findings for parasitic infections, no central bronchiectasis on previous HRCT, ANCA, ANA, ENA negative. She received an intensive course of corticosteroids with complete resolution of symptoms and the eosinophilia, as well as decreased infiltrates on chest radiograph. Doses of corticosteroids slowly reduced a maintained until June 2009. Her asthma often exacerbates so far and needs intermittent courses of corticosteroids, is difficult- to-treat, but without any relapses of ICEP. CONCLUSIONS: Clinicians should consider pulmonary eosinophilia in the differential diagnosis of patients treated for asthma who develop pulmonary infiltrates with dyspnea.