title: A case of eosinophilic pneumonia in a tobacco harvester.
abstract: BACKGROUND
  Eosinophilic pneumonia comprises a group of lung diseases in which eosinophils appear in increased numbers in the lungs. The distinct etiology of eosinophilic pneumonia is unknown, although the previous case series have indicated a relationship between acute eosinophilic pneumonia and the exposure to exogenous substances including the constituents of cigarettes.
  
  
  METHODS
  A 60-year-old nonsmoking female, who had started to harvest and sort tobacco leaves two months before presentation, was admitted because of persistent coughing, breathlessness, and general malaise. Her laboratory findings revealed eosinophilia. Chest computed tomography showed nonsegmental airspace consolidations bilaterally. A bronchoalveolar lavage fluid analysis also revealed that the numbers of total cells and eosinophils had increased. Although the urine level of cotinine was within the normal range, positive findings were found in the skin scratch-patch tests using tobacco leaf and its extracts, and a biopsy specimen obtained from the positive site demonstrated infiltration of eosinophils in the dermis. The patient was successfully treated with corticosteroids.
  
  
  CONCLUSIONS
  Green tobacco sickness, a type of nicotine poisoning caused by the dermal absorption of nicotine, is a well known occupational illness of tobacco harvesters. Although it is unclear whether the present case could be identified as a subtype of green tobacco sickness, this is the first report of eosinophilic pneumonia occurred in a tobacco harvester which was possibly induced by tobacco leaf exposure.
authors: Department of Internal Medicine 2, Oita University Faculty of Medicine, Oita, Japan.
authors: Daisuke
authors: D
authors: Yoshioka
authors: Hiroshi
authors: H
authors: Ishii
authors: Yutaka
authors: Y
authors: Hatano
authors: Kenji
authors: K
authors: Umeki
authors: Noriho
authors: N
authors: Sakamoto
authors: Ryo
authors: R
authors: Shirai
authors: Sakuhei
authors: S
authors: Fujiwara
authors: Jun-ichi
authors: J
authors: Kadota
mesh_terms: D005260:Female; D006801:Humans; D008875:Middle Aged; D016273:Occupational Exposure / Q000009:adverse effects*; D011657:Pulmonary Eosinophilia / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D014026:Nicotiana / Q000009:adverse effects*