Eosinophilic Lung Diseases

Eosinophilic lung disease (ELD) comprises a group of disorders that affect the lungs and manifest with blood and/or tissue eosinophilia. ELD may be secondary to a variety of conditions such as infection by parasites (e.g. ascariasis, strongyloidiasis, paragonimiasis, etc.), drug reaction, bronchopulmonary aspergillosis (ABPA) and malignancy. ELD may also be a primary process either limited to the lung (e.g. acute and chronic eosinophilic disease) or as part of a systemic disorder (e.g. allergic granulomatosis with polyangiitis or hypereosinophilic syndrome). On imaging ABPA is characterized by tubular branching opacities that may exhibit the finger-in-glove sign (i.e. inspissated mucus within dilated central bronchi). Strongyloidiasis often manifests with multifocal pulmonary opacities affecting all pulmonary lobes. AEP may simulate cardiogenic pulmonary edema on imaging. Chronic eosinophilic pneumonia (CEP) may have varied imaging manifestations, including the so-called “photographic negative of pulmonary edema”.

Eosinophilic Granulomatosis with Polyangiitis Manifesting as Recurrent Nasal Polyps and Hemorrhagic Necrotic Bullae: A Rare Disease Successfully Treated with Azathioprine

Eosinophilic granulomatosis with polyangiitis (EGPA) is a rare multisystemic vasculitis which was previously called Churg-Strauss syndrome or allergic granulomatosis. It has an unknown pathogenesis, possibly autoimmune in nature. As it has a low incidence, there is only scant published literature. This case report is valuable to dermatologists, since skin involvement is one of the most common features of the vasculitic phase. This report represents one of the possible presentations of EGPA according to the antineutrophil cytoplasmic antibody status – which in our case was negative, with a low prognostic Five-Factor Score – that was successfully treated with oral steroids and azathioprine as a steroid-sparing agent. Our objective was to add a case report to the scarce existing literature in order to learn more about therapeutic options for EGPA. This case report demonstrates that oral steroids, as induction treatment, and azathioprine, as maintenance treatment, are effective in elderly patients with EGPA without involvement of any other organs. Nevertheless, additional studies are necessary to achieve appropriate management.

Rapidly Progressive Glomerulonephritides, Diagnostic and Therapeutic Urgency

Rapidly progressive glomerulonephritides are relatively rare but serious disorders of diverse etiology, which share some clinical features: rapid evolution, progressive to renal failure, often accompanied by oliguria or anuria. They are characterized histopathologically by an intense extracapillary proliferation, with the development of crescents (semilunar lesions) in over 50% of examined glomeruli. The following pathological entities are referred to as rapidly progressive glomerulonephritides: ANCA-positive pauci-immune vasculitides (microscopic polyangiitis, granulomatosis associated with microscopic polyangiitis, allergic granulomatosis associated with microscopic polyangiitis), extracapillary proliferative glomerulonephritides by immune complexes and glomerulonephritides by anti-glomerular basement membrane antibodies. Due to major histopathological and functional complications, their evolution to death or renal replacement therapy occurs within 6-2 months after the diagnosis, if they are not treated, but the evolution is favorably influenced by aggressive immunosuppression, whether or not associated with plasmapheresis.