title: Early diagnosis based on clinical history and BALF for successful management of smoking-induced acute eosinophilic pneumonia without unnecessary antibiotic usage: a case report.
abstract: BACKGROUND
  Acute eosinophilic pneumonia (AEP) is a rapid onset and severe respiratory illness characterized by acute febrile respiratory insufficiency, eosinophilic infiltration in the lungs and unique findings on chest imaging. Difficulty in differentiating from other respiratory distress caused by community-acquired pneumonia may result in a delayed diagnosis or treatment with empirical antibiotics.
  
  
  METHODS
  Sixteen-year-old boy who developed AEP with marked eosinophilia in bronchoalveolar lavage fluid (BALF, 36.6%), decreased diffusion capacity of the lung for carbon monoxide (62%) and unique radiological findings. Although he initially denied tobacco use, on repeated thorough clinical history questioning, he eventually admitted beginning smoking 19 days before the onset of symptoms with gradually increasing frequency.
  
  
  RESULTS
  His symptoms resolved quickly without use of antibiotics after cessation of tobacco and treatment with corticosteroids.
  
  
  CONCLUSIONS
  Careful clinical history taking regarding tobacco use combined with early examination of BALF and recognition of unique radiological findings are critical for proper management of AEP.
authors.affiliation: a Department of Pediatrics .
authors.forename: Jee In
authors.initials: JI
authors.lastname: Song
authors.affiliation: b Division of Respiratory and Allergy Medicine , Department of Internal Medicine , and.
authors.forename: Yang-Ki
authors.initials: YK
authors.lastname: Kim
authors.affiliation: c Department of Radiology , Soonchunhyang University Hospital, Soonchunhyang University College of Medicine , Seoul , Korea.
authors.forename: Jung Hwa
authors.initials: JH
authors.lastname: Hwang
authors.affiliation: a Department of Pediatrics .
authors.forename: Hyeon-Jong
authors.initials: HJ
authors.lastname: Yang
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents; D001992:Bronchoalveolar Lavage Fluid; D042241:Early Diagnosis; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use*; D011657:Pulmonary Eosinophilia / Q000175:diagnosis* / Q000188:drug therapy* / Q000209:etiology; D012074:Remission Induction; D012907:Smoking / Q000009:adverse effects
chemical_list: D000900:Anti-Bacterial Agents; D005938:Glucocorticoids; D008775:Methylprednisolone
keywords: Bronchoalveolar lavage fluid; child; medical history taking; pulmonary eosinophilia; tobacco smoke pollution.