Eosinophilic alveolitis in BAL after lung transplantation

Lung transplantation has become a therapeutic option for patients with end stage lung disease. However, outcome after transplantation is complicated by episodes of rejection and infections. Bronchoalveolar lavage is a valuable tool in monitoring patients after transplantation, since it allows the detection of pathogens. A marker specifically indicating rejection from changes in BAL fluid has not been found yet. Especially changes in differential cell count, like lymphocytosis or an increase in polymorphnuclear granulocytes, are unspecific. The role of high eosinophil levels in BAL has not been elucidated yet. We analyzed 25 BAL samples and clinical data of 4 patients who underwent lung transplantation and presented with recurrent episodes of eosinophilic alveolitis in BAL. All patients demonstrated a deterioration of clinical condition, lung function, and blood gas analysis during times of eosinophilia in BAL, compared to previous examinations. In all cases, eosinophilia in BAL was accompanied by rejection. All patients were finally treated with high doses of steroids, resulting in improvement of all parameters. Eosinophilia was not associated with significant changes in the IL-5 concentration in BAL or the pattern of IL-5 expression in BAL cells. In conclusion, eosinophilic alveolitis may indicate acute rejection in patients after lung transplantation, if other causes of eosinophilia are excluded. Received: 20 July 1998 Received after revision: 10 December 1998 Accepted: 21 December 1998     

Eosinophilic granuloma of the lung presenting as a solitary pulmonary nodule.

A symptomless 58 year old man had an eosinophilic granuloma of the lung that presented as a solitary pulmonary nodule rather than the usual diffuse reticulonodular shadow on the chest radiograph. Only one previous case presenting in this way has been described.     

Eosinophilic Colitis

Eosinophilic colitis is a rare chronic inflammatory bowel condition of unknown etiology. We report a case of cecal volvulus causing obstruction in a patient with eosinophilic colitis. A 48-year-old lady presented with abdominal pain, constipation, and abdominal distension. Clinically and radiologically, she was diagnosed to have cecal volvulus. Preoperative colonoscopic reduction failed. At laparotomy, a right hemicolectomy with primary anastomosis was undertaken. Histology of the resected specimen showed diffuse eosinophilic infiltration suggesting eosinophilic colitis. To the best of our knowledge, this association has been never reported.     

Eosinophilic Gastroenteritis

Two cases of eosinophilic gastroenteritis are reported, with a discussion of eosinophilia in general and the incidence of various disorders which may be associated zvith it.     

Eosinophilic cystitis

4 cases of eosinophilic granulomatous cystitis are reported. The clinical presentation of this rare entity is disucssed. It is suggested that the lesion is probably akin to eosinophilic enteritis or eosinophilic granuloma of the gastrointestinal tract and represents a local intense allergic reaction of eosinophilic type. The causative agents are yet to be identified. Management by an allergist is suggested as a first line of treatment as it appears that the bladder lesions are usually too extensive for local resection.     

Eosinophilic cystitis

The fourteenth documentation of eosinophilic cystitis is presented with a review of the features characterizing this disorder.