title: Chronic cough and an atypical pattern of peripheral pulmonary opacities: A case report secondary to suspected drug onset.
abstract: Chronic eosinophilic pneumonia (CEP) is an idiopathic interstitial lung disease with nonspecific symptoms that involves a complex inflammatory cascade.
  
  
  
  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.
  
  
  
  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.
  
  
  
  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.
authors.affiliation: a Department of Internal Medicine , Saint Mary/Harbor-UCLA Medical Centers , Long Beach , CA , USA.
authors.forename: Ronnie
authors.initials: R
authors.lastname: Alas
authors.affiliation: b University of California San Francisco School of Medicine , San Francisco , CA , USA.
authors.forename: Mark Tony
authors.initials: MT
authors.lastname: Williams
authors.affiliation: c Department of Radiology , University of California San Diego School of Medicine , San Diego , CA , USA.
authors.forename: Ghiam
authors.initials: G
authors.lastname: Yamin
authors.affiliation: d Kaiser Permanente Fontana Medical Center , Fontana , CA , USA.
authors.forename: Mohsen
authors.initials: M
authors.lastname: Rofoogaran
mesh_terms: D000068879:Adalimumab / Q000009:adverse effects*; D000328:Adult; D001249:Asthma / Q000097:blood / Q000139:chemically induced / Q000175:diagnosis* / Q000188:drug therapy; D001772:Blood Cell Count; D002908:Chronic Disease; D003371:Cough; D004804:Eosinophils; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging; D008297:Male; D011329:Prisoners; D011565:Psoriasis / Q000188:drug therapy*; D011657:Pulmonary Eosinophilia / Q000097:blood / Q000139:chemically induced / Q000175:diagnosis* / Q000188:drug therapy; D014057:Tomography, X-Ray Computed
chemical_list: D005938:Glucocorticoids; D000068879:Adalimumab
keywords: Case reports; control/management; diagnostics; immunopathogenesis; therapy