March 2021 Pulmonary Case of the Month: Transfer for ECMO Evaluation

Abstract

No abstract available. Article truncated after 150 words. A 31-year-old male fire fighter with a history of recurrent “atypical pneumonia,” environmental and drug allergies, nasal polyps, asthma, and Crohn's disease (not on immunosuppressants) was transferred from an outside hospital for management of acute hypoxic respiratory failure with peripheral eosinophilia. Prior to admission he reported a 2-week history of worsening dyspnea, productive cough and wheezing, prompting an urgent care visit where he was prescribed amoxicillin-clavulanate for suspected community acquired pneumonia. Despite multiple days on this medication, his symptoms significantly worsened until he was unable to lie flat without coughing or wheezing. He was ultimately admitted to an outside hospital where his labs were notable for a leukocytosis to 22,000 and peripheral eosinophilia with an absolute eosinophil count of 9700 cells/microL. His blood cultures and urine cultures were negative, and a radiograph of the chest demonstrated bilateral nodular infiltrates. With these imaging findings combined with the peripheral eosinophilia there was …

Keywords

• eosinophilia
• valley fever
• acute eosinophilic pneumonia
• bronchoalveolar lavage
• causes
• chest x-ray
• coccidioidomycosis
• differential diagnosis
• drug-induced
• eosinophilic pneumonia