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A case report of phenytoin-induced eosinophilic pneumonia.

ABSTRACT: Eosinophilic pneumonia comprises a rare and potentially serious group of lung diseases characterized by abnormal accumulation of eosinophils in the lungs. Many medications including the anticonvulsant phenytoin, have been implicated in the development of eosinophilic pneumonia. Attributing eosinophilic pneumonia to a medication or toxin can be difficult and may only be achieved by exclusion. The process can be particularly challenging in polypharmacy and when there has been long-term use. Notwithstanding, the presence of a potential offending drug/agent, exclusion of other causes of eosinophilic pneumonia, clinical improvement after cessation of the offending agent, or return of eosinophilic pneumonia after re-challenge are strong indicators for a drug-induced diagnosis. We report a case of phenytoin-induced eosinophilic pneumonia that resolved after medication withdrawal. Considering drug toxicity as a possible etiology of eosinophilic pneumonia is important to allow for the prompt removal of the causative agent, which can result in clinical cure.

SUBMITTER: Annoh Gordon R

PROVIDER: S-EPMC6710233 | biostudies-literature | 2019

REPOSITORIES: biostudies-literature

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A case report of phenytoin-induced eosinophilic pneumonia.

Annoh Gordon Rhoda R Silhan Leann L

Respiratory medicine case reports 20190811

Eosinophilic pneumonia comprises a rare and potentially serious group of lung diseases characterized by abnormal accumulation of eosinophils in the lungs. Many medications including the anticonvulsant phenytoin, have been implicated in the development of eosinophilic pneumonia. Attributing eosinophilic pneumonia to a medication or toxin can be difficult and may only be achieved by exclusion. The process can be particularly challenging in polypharmacy and when there has been long-term use. Notwit ...[more]

PMID: 31463188

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Project description:BACKGROUND:Acute eosinophilic pneumonia (AEP) is a rare idiopathic lung disease characterized by pulmonary eosinophilia. The epidemiology of AEP remains understudied; however, past reports have reported that AEP can be caused by an allergic reaction to medications, such as antibiotics or inhaled antigens, such as tobacco smoke. AEP usually occurs bilaterally. However, we encountered an unusual case of antibiotic-induced eosinophilic pneumonia showing unilateral consolidation just on the operative side, which was initially diagnosed as postoperative bacterial pneumonia and treated with antibiotic therapy. The prescribed antibiotics paradoxically provoked AEP and worsened the patient's condition. Here, we report this antibiotic-induced AEP case showing unilateral consolidation only on the operative side which could be triggered by surgery for primary lung cancer. CASE PRESENTATION:A 74-year-old man underwent right upper lobectomy for lung adenocarcinoma. On postoperative day (POD) 9, an interstitial shadow appeared in the right lower lung field of the chest radiographs, along with a fever of 38.5?°C, dyspnea needing oxygen supplementation, and increased purulent sputum production, suggesting postoperative bacterial pneumonia. Despite administration of the broad-spectrum antibiotic, meropenem, the fever did not improve, and pulmonary opacity gradually worsened. Blood analysis showed increased peripheral eosinophils at 1182/mm3. The meropenem treatment was discontinued and bronchoscopy was performed for further evaluation, and the bronchoalveolar lavage fluid assessment showed a remarkable increase in the eosinophil population (51%). The drug lymphocyte stimulation test (DLST) for meropenem was positive. We diagnosed the patient with antibiotic-induced unilateral AEP, after which corticosteroid treatment was initiated. The patient subsequently improved and the infiltration in the right lower lung field completely disappeared. The patient was discharged on POD 43 without oxygen supplementation and is doing well without tumor recurrence 16?months after the surgery. CONCLUSIONS:Unilateral drug-induced AEP is rare. Nonetheless, it should be recognized as a differential diagnosis of postoperative pneumonia even in cases of a unilateral radiographic infiltration, because the lung operation itself could trigger this type of AEP.

Dataset Information

A case report of phenytoin-induced eosinophilic pneumonia.

Publications

A case report of phenytoin-induced eosinophilic pneumonia.

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