Chronic cough and an atypical pattern of peripheral pulmonary opacities: A case report secondary to suspected drug onset

ABSTRACT

Introduction: Chronic eosinophilic pneumonia (CEP) is an idiopathic interstitial lung disease with nonspecific symptoms that involves a complex inflammatory cascade. Case study. A 36-year-old prisoner with a history of psoriasis presented with progressive worsening dyspnea, chest pain, and cough. His symptoms started 2-months after starting adalimumab, a tumor necrosis factor (TNF)-inhibitor, for psoriasis treatment. Results. Initial workup revealed 27% eosinophils on complete blood count, elevated IgE levels on bronchoalveolar lavage, and bilateral peripheral lung opacities on imaging. The patient's symptoms and eosinophilia improved markedly after starting corticosteroids. Based on these findings, the patient was diagnosed with CEP. Conclusion. To our knowledge, this is the first case of asthma and CEP in a patient taking adalimumab. We suspect adalimumab unmasked the Th2 cell pathway response that was otherwise suppressed by psoriasis, a primarily Th1 cell pathway disease. The patient's pulmonary changes can be attributed to an eosinophilic asthma phenotype with adalimumab putatively indirectly causing CEP.

KEYWORDS:

• Case reports
• control/management
• diagnostics
• immunopathogenesis
• therapy

Acknowledgements

The authors are grateful to Sharon Williams, MD, for help in editing and critical review of this manuscript. RA and MR were responsible for treating the patient. RA, MTW, GY, and MR drafted the manuscript. All authors read and approved the final manuscript.

Declaration of interests

The authors declare no conflicts of interest, financial or otherwise.