@article{1583723030504e3f994907a5991ab965,
title = "Sulfa-induced acute eosinophilic pneumonia",
abstract = "Acute eosinophilic pneumonia (AEP) is an infrequently seen interstitial lung disease secondary to medications. We report a series of 3 case of severe AEP which developed as a result of sulfa medication. 2 patients had received treatment with sulfamethoxazole for acne and 1 was treated with sulfasalazine for colitis. Patients were on sulfa medication for 1–3 weeks prior to presentation. All patients presented with fever, acute onset bilateral pulmonary infiltrates as well as marked peripheral eosinophilia. Mean eosinophil count was 2.21 × 109/L. There was a lack of response to steroids. One patient required extracorporeal membrane oxygenation and prolonged mechanical ventilation via tracheostomy. 2 patients underwent successful lung transplantation (1 bilateral living-related lobar lung transplant and 1 orthotropic cardiopulmonary allotransplantation). In all cases lung biopsy and explants showed acute and organizing diffuse alveolar damage with increased interstitial and airspace eosinophils. To our knowledge, our series is the first to show the clinical features of sulfa induced AEP in an adolescent population.",
keywords = "Acute eosinophilic pneumonia, ECMO, Lung transplant, Sulfa-induced",
author = "Faria Nasim and Paul, {Jose Antony} and Jennifer Boland-Froemming and Wylam, {Mark E.}",
note = "Funding Information: Although, steroids administration in the background of AEP didn't relieve symptoms or improved clinical outcomes significantly in our patients, steroids have been supported as the treatment of choice [18]. Upwards of 16% of patients require an intubation and mechanical ventilation. Refractory hypoxemia requiring institution of ECMO has been reported in one 15 year old and one 23 year old case with AEP [19,20]. Two of our patients required protracted ECMO support. Severe hypoxemia requiring institution of ECMO with AEP in adults has not been reported. This suggests a rapidly developing aggressive pathology with AEP in adolescents. ECMO while waiting for recovery with high dose corticosteroids or while awaiting lung transplantation is a reasonable approach for patient management in the adolescent, otherwise healthy individuals. There are reports of severe and rapidly progressive AEP leading to fatality [12,21]. To the best of our knowledge, there are no reports of lung transplantation in AEP. Acute eosinophilic pneumonia should be considered early in the differential with acute respiratory distress syndrome in the presence of peripheral eosinophilia. Early suspicion and diagnosis are necessary to discontinue the offending agent and start timely high dose corticosteroids in fulminant refractory hypoxemic respiratory failure. Publisher Copyright: {\textcopyright} 2021",
year = "2021",
month = jan,
doi = "10.1016/j.rmcr.2021.101496",
language = "English (US)",
volume = "34",
journal = "Respiratory Medicine Case Reports",
issn = "2213-0071",
publisher = "Elsevier BV",
}