Eosinophilic pneumonia as a presentation of occult chronic granulomatous disease.

We present a case of invasive pulmonary aspergillosis (IPA) in a previously healthy young woman who presented with what initially appeared to be an acute eosinophilic pneumonia. A second lung biopsy taken after treatment with steroids showed invasive Aspergillus with associated necrotizing granulomas, a pattern commonly found in chronic granulomatous disease (CGD). Both siblings, and by extrapolation, the patient, were actually found to have CGD. A review of the literature revealed other cases of presumed immunocompetent patients with IPA with presentations and lung histopathology similar to that of our patient. We conclude that chronic granulomatous disease presenting in the adult may be more common than previously assumed, and that patients previously presumed immunocompetent, but with granulomatous invasive pulmonary aspergillosis, may have chronic granulomatous disease. Furthermore, and most devastatingly in this case, the presentation may simulate a recently described steroid responsive acute lung disease, acute eosinophilic pneumonia.

[1]  M. Gahr,et al.  Chronic granulomatous disease in adults , 1996, The Lancet.

[2]  C. Moskaluk,et al.  Surgical pathology of the lung in chronic granulomatous disease. , 1994, American journal of clinical pathology.

[3]  G. Rodgers,et al.  Acute eosinophilic pneumonia with respiratory failure: a new syndrome? , 1992, The American review of respiratory disease.

[4]  J. Golden,et al.  Microgranulomatous aspergillosis after shoveling wood chips: report of a fatal outcome in a patient with chronic granulomatous disease. , 1992, American journal of industrial medicine.

[5]  P. Newburger,et al.  Chronic granulomatous disease presenting in a 69-year-old man. , 1991, The New England journal of medicine.

[6]  G. Kurland,et al.  Fatal pulmonary aspergillosis presenting as acute eosinophilic pneumonia in a previously healthy child. , 1991, Chest.

[7]  H. Wiedemann,et al.  Hypersensitivity pneumonitis versus invasive pulmonary aspergillosis: two cases with unusual pathologic findings and review of the literature. , 1991, The American review of respiratory disease.

[8]  E. Pacht,et al.  Acute eosinophilic pneumonia as a reversible cause of noninfectious respiratory failure. , 1989, The New England journal of medicine.

[9]  H. Zakhour,et al.  Locally invasive pulmonary aspergillosis occurring in a gardener: an occupational hazard? , 1989, Thorax.

[10]  D. Badesch,et al.  Acute eosinophilic pneumonia: a hypersensitivity phenomenon? , 1989, The American review of respiratory disease.

[11]  W. Whitelaw,et al.  Fatal Aspergillus pneumonia in chronic granulomatous disease. , 1986, American journal of clinical pathology.

[12]  S. Rodenhuis,et al.  Invasive pulmonary aspergillosis in a non-immunosuppressed patient: successful management with systemic amphotericin and flucytosine and inhaled amphotericin. , 1984, Thorax.

[13]  T. Aldrich,et al.  Invasive aspergillosis of the lung and pericardium in a nonimmunocompromised 33 year old man. , 1981, The American journal of medicine.

[14]  D. Strong,et al.  Extrinsic allergic alveolitis after Aspergillus fumigatus inhalation. Evidence of a type IV immunologic pathogenesis. , 1976, The American journal of medicine.