1. Pulmonary Infiltrates with Eosinophilia
Hassan Ghobadi MD
Assistant professor of Internal Medicine
Ardabil University of Medical Science

2. Introduction
PIE, Eosinophilic pneumonias include syndromes characterized by eosinophilic pulmonary infiltrates and, commonly, peripheral blood eosinophilia.
This group of disorders has been classified to:
1- Known etiology
2- Unknown etiology

3. PIE Syndrome
Drug-induced eosinophilic pneumonias are the most common cause of eosinophilic pulmonary infiltrates.
Treatment consists of withdrawal of the incriminated drugs and the use of glucocorticoids, if necessary.

4. Pulmonary Infiltrates with Eosinophilia
Etiology Known
1- Allergic bronchopulmonary mycoses
2- Parasitic infestations
3- Drug reactions
4- Eosinophilia-myalgia syndrome
Etiology Unknown
1- Loeffler's syndrome
2- Acute eosinophilic pneumonia
3- Chronic eosinophilic pneumonia
4- Allergic granulomatosis of Churg and Strauss
5- Hypereosinophilic syndrome

5. Allergic bronchopulmonary aspergillosis
When an eosinophilic pneumonia is associated with atopic asthma, and has skin reactivity to Aspergillus.
If so, other criteria should be sought for the diagnosis of allergic bronchopulmonary aspergillosis (ABPA) .
The chest roentgenogram in ABPA may show transient, recurrent infiltrates or may suggest the presence of proximal bronchiectasis .
High-resolution chest CT is a sensitive, noninvasive technique for the recognition of proximal bronchiectasis.
Adequate treatment usually requires the long-term use of systemic glucocorticoids.

6. Diagnostic Features of ABPA
Main Diagnostic Criteria
1- Bronchial asthma
2- Pulmonary infiltrates
3- Peripheral eosinophilia (>1000/ L)
4- Immediate wheal-and-flare response to Aspergillus fumigatus
5- Serum precipitins to A. fumigatus
6- Elevated serum IgE
7- Central bronchiectasis
Other Diagnostic Features
1- History of brownish plugs in sputum
2- Culture of A. fumigatus from sputum
3- Elevated IgE (and IgG) class antibodies specific for A. fumigatus

7. Pulmonary Infiltrates with Eosinophilia
Acute eosinophilic pneumonia is an idiopathic acute febrile illness of < 7 days' duration with severe hypoxemia, pulmonary infiltrates, and no history of asthma.
Chronic eosinophilic pneumonia presents with significant systemic symptoms including fever, chills, night sweats, cough, anorexia, and weight loss of several weeks' to months' duration.
The chest x-ray classically shows peripheral infiltrates.
Dramatic clearing of symptoms and chest x rays is often noted within 48 h after initiation of glucocorticoid therapy.