A case of idiopathic pulmonary fibrosis with chronic eosinophilic pneumonia

A 58 year-old man was admitted to our hospital with complaints of dyspnea and cough. Chest X-ray examination revealed diffuse nodular shadow, infiltration in the left upper and lower lobes, and volume loss. BALF showed increased number of cells, particularly eosinophils (65.6%). Eosinophilia (17-13%) was also seen. The histological examination of the TBLB specimen revealed irregular thickening and edema of alveolar septa. From these findings together with clinical features the case was diagnosed as eosinophilic pneumonia. Oral administration of prednisolone started with 30 mg. Within a week, eosinophilia in peripheral blood decreased to 1%, PaO2 increased to 87.5 Torr in room air, and CRP became negative. His chest X-ray film showed the disappearance of infiltrative shadows in the left upper and lower lobes. On the 19th day was prednisolone decreased to 20 mg. Laboratory data and chest roentgenogram showed exacerbation, and PaO2 gradually decreased to 62.9 Torr. Patchy shadows were seen in the right upper lobe. The dose of prednisolone was again increased to 60 mg/day, and was quite effective. The drug dosage was tapered by 10 mg/10 days to 40 mg/day, however all data exacerbated again. The clinical course seemed peculiar for eosinophilic pneumonia, however small reticulonodular shadows on chest X-ray did not change. Therefore, open lung biopsy was performed. The histology of the specimen showed fibrosis, lymphocyte infiltration and thickening of alveolar septa. The clinical course and histopathological findings led to a diagnosis of idiopathic pulmonary fibrosis accompanied with chronic eosinophilic pneumonia.