Eosinophilic pneumonia is characterised histologically by the accumulation of eosinophils in the alveolar air spaces and infiltration of the adjacent interstitial space by eosinophils and variable numbers of lymphocytes and plasma cells. Peripheral blood eosinophilia is present in around 40% of patients. Eosinophilic pneumonia secondary to drug reaction is seen most commonly in association with methotrexate, sulfasalazine, para-aminosalicylic acid, nitrofurantoin and non-steroidal anti-inflammatory drugs. Chest radiography and HRCT show bilateral airspace consolidation, which tends to involve mainly the peripheral lung regions and the upper lobes.
The diagnosis of drug-induced disease will be missed unless specifically sought as a cause of unexplained diffuse pulmonary shadowing in patients at known risk with clinical symptoms of lung disease. It is particularly important, though often difficult, to differentiate between drug-induced disease, infections (particularly of the opportunistic variety) and metastatic malignancy in patients who are susceptible to these processes.
Classic HRCT Findings
• Imaging findings of most drug reactions are nonspecific and mimic those of various acute and chronic lung diseases
• A drug-specific diagnosis is rarely possible
• The main role of HRCT in this setting is the exclusion of other diseases
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