Abstract
Introduction: Pulmonary infiltrates with eosinophilia (PIE) are a group of rare heterogeneous disorders in children, with systemic symptoms and common finding of lung disease and eosinophilia in peripheral blood, bronchoalveolar lavage fluid (BAL) or pulmonary interstitium. The most frequent cause is parasite induced. However, chronic eosinophilic pneumonia can be confused with infectious pneumonia.
Case: A 14 year old girl with 2 months of fever, cough, dyspnea, weight loss and finally respiratory failure without resbronse to antibiotic therapy. Chest X-ray and high resolution tomography (HRCT) showed diffuse interstitial infiltrates and bilateral condensation involving mainly the superior lobes. BAL showed eosinophilia (46%) and in peripheral blood 8 976/mm3. Blood, sputum and BAL cultures were negative. A diagnosis of chronic eosinophilic pneumonia was made and antibiotics were stooped. Systemic steroids were started and after 5 days there was clinical improvement. Chest X-ray was normal after 2 weeks and the HRCT after 9 months. Lung biopsy showed bronchiolitis obliterans with an organized pneumonia with diffuse cellular infiltrates, mainly histiocytes.
Conclusion: Owing to the mortality of this disease, the diagnosis should be suspected in children with respiratory failure, failure to improve with antibiotics and diffuse infiltrates in the chest X-ray or HRCT.
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