rifampin and Pulmonary-Eosinophilia

It were Liebow et al. (1965) who, for the first time, described the desquamative interstitial pneumonia (DIP) as one clinical and morphological unit. The etiopathology of this disease is still unknown and there exist many controversial opinions as to its role within the interstitial pneumonias. For the clinical-physician the DIP represents a difficult problem because there seems to be no uniform appearance to this disease. So a lung-biopsy is the unique way to make a definitive diagnosis. The following description represents a case of DIP observed at our hospital. At the same time we tried to give a review of our present knowledge concerning the morphology, course and therapy of this disease. We think it should be note that the DIP was accompanied by an extreme peripheral eosinophilia. To our knowledge this is the first time such a phenomenon is described. In the course of the treatment with steroids the eosinophilia disappeared parallel to the normalization of the radiographic findings.

Topics: Adrenal Cortex Hormones; Adult; Alveolitis, Extrinsic Allergic; Collagen Diseases; Diagnosis, Differential; Eosinophilia; Female; Histiocytosis, Langerhans-Cell; Humans; Isoniazid; Lung; Pneumonia; Pulmonary Eosinophilia; Radiography; Rifampin; Tetracycline

Eosinophilic lung diseases (ELD) are a variety of several clinical entities, which may result from different etiologies, including drug treatment. Dapsone, a sulfone antibiotic widely used in leprosy (among other indications), has been described as a possible cause of ELD. We report a patient with leprosy who presented with respiratory symptoms and pulmonary infiltrates and was diagnosed as suffering from eosinophilic pneumonia. To the best of our knowledge, this is the first report in which the diagnosis of dapsone-induced eosinophilic pneumonia was supported by bronchoalveolar lavage, lung biopsy and typical response to therapy.

Topics: Aged; Biopsy; Clofazimine; Dapsone; Humans; Leprostatic Agents; Leprosy, Lepromatous; Male; Pulmonary Eosinophilia; Rifampin

A 67 year old woman presented with miliary tuberculosis. She was treated with streptomycin, isoniazid, rifampicin, ethambutol and pyrazinamide. However, she developed rifampicin-induced thrombocytopenia after 6 weeks of treatment, and skin rash, blood eosinophilia and pulmonary infiltrates after 8 weeks of therapy. The latter was found to be ethambutol related. Additional evidence, including blood and sputum eosinophilia and the rapidity of its response to corticosteroid, suggested that the pulmonary infiltrates might also be eosinophilic in nature. To the best of our knowledge, this constitutes the first report of such adverse drug reaction, induced by ethambutol.

Topics: Aged; Drug Eruptions; Drug Therapy, Combination; Eosinophilia; Ethambutol; Female; Humans; Isoniazid; Pulmonary Eosinophilia; Pyrazinamide; Radiography; Rifampin; Streptomycin; Thrombocytopenia; Tuberculosis, Miliary