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Mechanisms of acute eosinophilic inflammation in a case of acute eosinophilic pneumonia in a 14‐year‐old girl
Author(s) -
Véronique Godding,
Eddy Bodart,
Monique Delos,
Yves Sibille,
Laurence Galanti,
Patrick De Coster,
Nizar N. Jarjour,
William W. Busse
Publication year - 1998
Publication title -
clinical and experimental allergy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.462
H-Index - 154
eISSN - 1365-2222
pISSN - 0954-7894
DOI - 10.1046/j.1365-2222.1998.00231.x
Subject(s) - medicine , eosinophil , pathology , eosinophilic , eosinophilic pneumonia , pleural effusion , immunostaining , eosinophilia , pathophysiology , pleural disease , immunohistochemistry , respiratory disease , lung , immunology , asthma
Background Acute eosinophilic pneumonia (AEP) is characterized by respiratory distress, eosinophilic infiltration in the lung, acute onset, resolution of symptoms with corticosteroids and the absence of relapse. Studies to identify the pathophysiology of AEP in adults have demonstrated eosinophil activation in the BAL fluid, and the presence of high levels of interleukin 5 (IL‐5) in the BAL. Objective To investigate the pathophysiology of AEP with pleural effusion in a paediatric patient. Methods ECP levels in the BALand pleural fluid was determined by radioimmunoassay. IL‐5 and GM‐CSF concentrations in the BAL and pleural fluid were measured by Elisa. Immunohistochemistry studies performed on open lung biopsy included a specific ICAM‐1 immunostaining and a ECP specific immunostaining (EG2 + ). Results High levels of ECP were found in the BAL (5 μg/L) and pleural fluid (750 μg/L) demonstrating eosinophil activation at these sites. Immunohistochemistry illustrated activated (EG2 + ) eosinophils in the interalveolar septa and alveolar space and detected increased expression of ICAM‐1 on alveolar epithelial cells. High levels of IL‐5 were measured in the BAL (1334 pg/mL) and pleural fluid (7014 pg/mL), while elevated concentrations of GM‐CSF (150 pg/mL) were found in the BAL. Conclusion We conclude that in this paediatric patient with AEP activated eosinophils were present in the BAL fluid, in the interalveolar septa and in the pleural space while increased ICAM‐1 expression was detected on alveolar epithelial cells, contributing, at least partly, for their adhesive interactions. IL‐5 and GM‐CSF are likely important to the massive eosinophil recruitment and activation in the lung, while IL‐5 is probably related to eosinophil accumulation and activation in the pleural space. Thus, lung generation of eosinophil‐active cytokines is central to the pathophysiology of AEP in paediatric patients.