Eosinophilic pneumonia following occupational smoke exposure

A 21-year-old male patient with a history of occupational exposure to open fire smoke was initially treated with empiric antibiotics for simple community-acquired pneumonia. However, he continued to deteriorate rapidly, developed respiratory failure and needed mechanical ventilation. After possible aetiologies were considered, acute eosinophilic pneumonia was suspected and confirmed by broncho-alveolar lavage. His condition improved dramatically soon after glucocorticoid administration and he was discharged without sequelae. Acute eosinophilic pneumonia should be considered in a patient with a history of exposure to smoke presenting with pneumonia that deteriorates rapidly despite broad antibiotics. An important clue for the diagnosis is eosinophilia in peripheral blood. LEARNING POINTS: Acute eosinophilic pneumonia (AEP) should be considered in any patient with pneumonia and peripheral blood eosinophilia. A detailed medical history, including exposure to cigarette or occupational smoke, is critical in all patients with pneumonia, especially in non-resolving cases. Once AEP is diagnosed, prompt glucocorticoid treatment usually leads to an immediate and dramatic response.