UN CASO INUSUALE DI INFILTRATI POLMONARI CON INTERASSAMENTO EPATICO IN UNA DONNA CON EOSINOFILIA

The literature reports many cases of eosinophilic pulmonary infiltrations, with different etiology. In our case clinical pictures were not very clear and specific at first and the clinical course was altered by an ex adjuvantibus steroid treatment before admission to hospital. It was new and unusual because it presented some characteristics of chronic eosinophilic pneumonia and idiopathic hypereosinophilic syndrome, with hepatic involvement as in the former, but without serious heart disease as in the latter. This confirms the difficulties in making a classification of the different clinical pictures because of their indistinct margins, which might appear as different forms of a single disease. In our case the patient refused transbronchial lung biopsy which is commonly considered a minimum diagnostic requirement. Some authors are not in agreement and think it is sufficient to find eosinophils in BAL to start steroid treatment, avoiding biopsy risks. Another interesting finding is the need for a long-term low-dose steroid treatment, to avoid relapses.