Photoclinic Diagnosis: Chronic (Cryptogenic) Eosinophilic Pneumonia (CEP)

A19-year-old lactating woman was referred to our hospital with cough, scanty sputum, increasing dyspnea, fever, night sweats, lassitude, and loss of weight for 8 months. Her illness started during pregnancy. Drug history was negative and she denied any personal or family history of tuberculosis, asthma or atopy. In physical examination, she seemed to be wasted. No adenopathy or organomegaly was documented and her heart and lungs were normal. Chest X-ray showed a patchy non-homogenous infiltrate in the lower part of the right lung (Figure 1) which was increased in size over time and involved the peripheral portion of the right hemi- thorax with no evidence of significant lymphadenopathy in 3 weeks (Figure 2). Liver function tests and routine chemistry were normal; Hb: 13g/dL, WBC: 18,400/μL with 30% PMN, 3% monocytes, 47% eosinophils, and 20% lymphocytes; platelets: 320,000/μL; ESR: 90 and 115 at the end of first and second hours respectively. Three consecutive stool examinations were negative for occult blood and parasites. Pulmonary function tests showed a severe restrictive pattern with FVC: 0.83/L (24% of normal), FEV1: 0.75/L (24% of normal), and EFV1/FVC=0.9.