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• W4387249920 abstract "SESSION TITLE: Asthma, Eosinophilia, and Cough SESSION TYPE: Rapid Fire Case Reports PRESENTED ON: 10/09/2023 09:40 am - 10:25 am INTRODUCTION: Eosinophilic bronchiolitis was first reported in 2001 [1]. Later, a diagnostic criteria for the disorder hyper eosinophilic obliterative bronchiolitis was proposed [2]. Cases of eosinophilic bronchiolitis were described in several Japanese case reports, and a French population case-series. Proposed diagnostic criteria includes: blood eosinophil cell count > 1 G/L and/or bronchoalveolar lavage eosinophil count > 25%; persistent airflow obstruction despite high-dose inhaled bronchodilators and corticosteroids; and eosinophilic bronchiolitis at lung biopsy and/or direct signs of bronchiolitis on computed tomography (CT) [2]. The treatment is not well defined. One case report has demonstrated success with long term oral corticosteroids [1]. Other reports have experimented with biologic therapies such as mepolizumab or benralizumab [2,3]We report a case of biopsy proven eosinophilic bronchiolitis that was successfully treated. CASE PRESENTATION: A 72-year-old Afro-Caribbean female was referred for wheezing, dyspnea and chronic cough. Prior to symptoms starting, she had no history of respiratory disease. She was initiated on long-acting beta-agonist and inhaled corticosteroids (LABA/ICS). Pulmonary function test (PFT) demonstrated a moderate obstruction, moderate restriction, but no gas transfer defect. Absolute eosinophil count was 0.690 K/uL. Acid fast was negative on sputum smear. CT chest demonstrated scattered regions of tree-in-bud airspace opacities most prominent in the bilateral lower lobes concerning for bronchiolitis and scattered bilateral pulmonary nodules. She then underwent bronchoscopy with bronchoalveolar lavage (BAL) in the right middle lobe (RML) with transbronchial biopsy of the RML. The bronchoscopy was grossly unremarkable. Infection was ruled out on BAL. Transbronchial biopsy demonstrated parabronchial soft tissue with increased eosinophils (>50/hpf). She was initiated on prednisone 0.5 mg/kg (20 mg). CT chest demonstrated improved tree-in-bud opacities and a slow taper was initiated. After five months, prednisone 5 mg daily was discontinued due to side effects. Her symptoms of wheezing and dyspnea returned, and she was restarted on 10 mg of prednisone daily (0.25 mg/kg). She remained on 10 mg for 3 months with complete resolution of symptoms. A slower taper was initiated and nocturnal montelukast was initiated. She has now been off oral glucocorticoids for 3 months in full remission of symptoms. Her current management is LABA/ICS, and nocturnal montelukast. Repeat PFT demonstrated resolution of obstruction. DISCUSSION: A clinical diagnosis of eosinophilic bronchiolitis was made based on imaging consistent with bronchiolitis and pathology demonstrating parabronchial eosinophil infiltration. This is the first time, to our knowledge, this disease has been observed in an Afro-Caribbean patient. Furthermore, remission was achieved using glucocorticoid taper and is now managed with inhaled corticosteroids. Previous reports have required the patient to stay on oral corticosteroid or receive biologic treatments. CONCLUSIONS: Eosinophilic bronchiolitis remains an underrecognized disease within the field of pulmonary medicine and more research is needed to better understand its disease process. Pulmonary physicians should consider eosinophilic bronchiolitis as a part of their bronchiolitis differential in the right clinical context. Reference #1: Takayanagi, Noboru, Minoru Kanazawa, Yoshinori Kawabata, and Thomas V. Colby. Chronic bronchiolitis with associated eosinophilic lung disease (eosinophilic bronchiolitis). Respiration 68, no. 3 (2001): 319-322. Reference #2: Cordier, Jean-François, Vincent Cottin, Chahéra Khouatra, Didier Revel, Clément Proust, Nathalie Freymond, Françoise Thivolet-Béjui, and Jean-Charles Glérant. Hypereosinophilic obliterative bronchiolitis: a distinct, unrecognised syndrome. European Respiratory Journal 41, no. 5 (2013): 1126-1134. Reference #3: Takeshita, Yuichiro, Seiichi Nobuyama, Yukiko Kanetsuna, Akihiko Tanaka, Mitsuru Adachi, Tetsuo Sato, and Yuji Tada. Eosinophilic bronchiolitis successfully treated with mepolizumab. The Journal of Allergy and Clinical Immunology: In Practice 8, no. 3 (2020): 1159-1161. DISCLOSURES: No relevant relationships by Huma Ahmed No relevant relationships by Riddhi Chauhan No relevant relationships by Joseph Gorga No relevant relationships by Ryan Kaiser" @default.
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• W4387249920 date "2023-10-01" @default.
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• W4387249920 title "A CASE OF EOSINOPHILIC BRONCHIOLITIS IN AN AFRO-CARIBBEAN FEMALE" @default.
• W4387249920 doi "https://doi.org/10.1016/j.chest.2023.07.106" @default.
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