okay well welcome to another MedCram lecture presented at med crammed calm
please join us over there at MIT cram comm where we've got great videos and
reviews we're gonna talk about again eosinophils pneumonia and we're gonna
round out this lecture with the top four that I think you ought to know and let's
get started first of all it's name what they are the primary eosinophilic
pneumonia is and divide them into two categories we're going to talk about the
lung and systemic so there's one in the lungs there are those systemic so
actually two in the lungs and two of them that are systemic
the first one is acute Jacinta philic pneumonia then we have chronic you'll
Cinna philic pneumonia and then here we have the hyper yo Cinna philic syndrome
I should say not pneumonia and finally the what we call e.g PA which you should
know stands for the eosinophilic granulomatosis with polyangiitis
otherwise known as CH you are gee that's churg-strauss str2 str1 and they are
different in some ways first of all let's talk about where the eosinophils
are found now as I mentioned usually they're found in both the lungs and the
blood and that's the case here so here I'm going to write both to show that
it's both in the blood and also in the lungs here it's us an affiliate is found
both in the lung and the blood and here as well both
in the lungs and the blood whereas here it's just found in the lungs so no blood
the way to think about that is an acute eosinophils pneumonia it's starting in
the lungs it doesn't have time to make it into the blood that might be a way to
think about it the next thing we want to look at is the the agender predilection
so whereas this is the unique one in terms of where the eosinophilia is found
this one here is the unique one in terms of the fact that it's typically found in
females whereas every other one is typically male predominant okay
now in terms of markers you should know that this one is unique in that the
major marker is P ANCA and all the other ones have il 5 mediation which makes
sense because that's the major issue with eosinophils
the other thing that's of course interesting is that you're gonna get
vasculitis and mono Plex neuropathy so neuropathy and vasculitis now the
theory is is that when people are put on leuco trying receptor antagonists that
you're able to as a result reduce the steroids that you have to use in people
with asthma and as a result of that when you reduce the steroids
it tends to cause this short strauss disease to come out now this has led
some people to believe that the that there actually is a connection between
LT Ras and this disease but that is hotly debated with eg PA or Turk Straus
syndrome the the biggest issue is morbidity and mortality from the heart
or cards it is typically seen in asthma so we'll put that in a different color
here for you asthma is big here of course in chronic
eosinophils pneumonia asthma is also big the other interesting thing here is that
that it's predominately in women but also on the x-ray it has the
photographic negative of pulmonary oedema what do I
mean by that if you were to look on the x-ray
whereas in pulmonary edema typically it's starting from the middle which is
what the vascularity is here it's towards the edge
okay now the treatments for all of these no surprise is steroids steroids for
acute eosinophils pneumonia and usually there is no relapse for chronic OSA no
philic pneumonia you guessed it steroids and they can get better within
hours two days but there may be a relapse so they need a longer course
perhaps even months typically months to make sure that the chronic ear DaSilva
pneumonia doesn't come back for Hyper yo Sinha philic syndrome the treatment is
steroids as well but in this case because the il5 you may use in il5
inhibitor which as you may recall is meeple is you map okay and then the
treatment here in trick Straus is steroids but you can also do more
rigorous steroids for instance like methotrexate and as a thigh print the
other thing that you might see as well is elevated IgE levels okay so what are
the things that I think are going to be important to understand for this you've
got to know for you of synthetic pneumonias that number one acute
eosinophils ammonia is only in the lungs so the only way you're going to make the
diagnosis is if you do a B al that's a bronchial alveolar lavage or a bronchus
bronchoscopy all the other ones are both in the lungs and in the serum in terms
of women this is the one they're gonna get most often the chronic the other
thing you ought to know is the photographic negative of pulmonary edema
that's very important these two are both very responsive to steroids the acute
does not relapse and you can think of it that it doesn't
relapse because it's only in the lungs and it's only in the lungs because it
hasn't had a chance to spread to the blood and that's because it's acute for
hyper eosinophils syndrome you're going to see multiple parts of the body
multiple organs involved you can because it's il5 mediated specifically here you
can use mutilation map which is an auto antibody against il5 but the treatment
is steroids and typically to get this diagnosis you need to have this for at
least six months so this is not a easy diagnosis sometimes over here they have
asthma for up to ten years so just so you're aware of that
so trick strauss remember that medications like leukotriene receptor
antagonists like montelukast can unmask it it's typically seen both in the blood
and also in the lungs typically male this Pianka is gonna give you a
vasculitis that is going to give you purpura it could give you nodules
petechiae you can even get a diffuse alveolar hemorrhage very rarely it's not
common you're gonna get neuropathy and you're gonna get morbidity and mortality
from cardiology issues remember steroids as a thyroid prynne and methotrexate
okay so a big picture know the difference between acute and chronic and
then know both or lungs thanks for joining us