title: Eosinophilic pneumonia presenting as life-threatening ARDS.
abstract: We present a case of a 25-year-old woman with sudden onset of shortness of breath, cough and malaise, 24 h after discharge from a psychiatric hospital. She had been there for 2 weeks after a suicide attempt with lye, and started treatment with paroxetin, alprazolam and valproic acid. She also started smoking 20 cigarettes/day during that hospital admission. Brought to the emergency department, she evolved in the first 24 h with respiratory failure and shock needing intensive care unit (ICU) admission, with mechanical ventilation and vasopressor support. Empiric antibiotic therapy was started (piperacillin-tazobactam and azithromycin) suspecting healthcare-associated pneumonia. The patient's chest radiography progressed with bilateral infiltrates. Peripheral blood eosinophilia was seen on the second day. A bronchoalveolar lavage was performed and had 50% of eosinophils. She was started on treatment with steroids and the next day no longer needed vasopressors; 4 days later she was extubated.
authors.affiliation: Department of Internal Medicine, Centro Hospitalar Porto, Porto, Portugal.
authors.forename: José Miguel
authors.initials: JM
authors.lastname: Maia
authors.affiliation: Centro Hospitalar Porto, Porto, Portugal.
authors.forename: Fernando
authors.initials: F
authors.lastname: Guedes
authors.affiliation: Department of Intensive Care Unit, Centro Hospitalar Porto, Porto, Portugal.
authors.forename: Irene
authors.initials: I
authors.lastname: Aragão
authors.affiliation: Department of Intensive Care Unit, Centro Hospitalar Porto, Porto, Portugal.
authors.forename: Teresa
authors.initials: T
authors.lastname: Cardoso
mesh_terms: D000328:Adult; D000525:Alprazolam / Q000627:therapeutic use; D018687:Antidepressive Agents, Second-Generation / Q000627:therapeutic use; D002424:Caustics / Q000506:poisoning*; D003371:Cough / Q000209:etiology / Q000276:immunology; D004359:Drug Therapy, Combination; D004802:Eosinophilia / Q000139:chemically induced* / Q000188:drug therapy / Q000276:immunology / Q000473:pathology; D004804:Eosinophils; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D008191:Lye / Q000506:poisoning*; D017374:Paroxetine / Q000627:therapeutic use; D011241:Prednisone / Q000627:therapeutic use; D011657:Pulmonary Eosinophilia / Q000150:complications / Q000175:diagnosis* / Q000276:immunology; D013902:Radiography, Thoracic; D012128:Respiratory Distress Syndrome / Q000175:diagnosis / Q000276:immunology; D013406:Suicide, Attempted; D016896:Treatment Outcome; D014635:Valproic Acid / Q000627:therapeutic use
chemical_list: D018687:Antidepressive Agents, Second-Generation; D002424:Caustics; D005938:Glucocorticoids; D008191:Lye; D017374:Paroxetine; D014635:Valproic Acid; D011241:Prednisone; D000525:Alprazolam