C42-35 Infliximab Induced Eosinophilic Pneumonia Presenting With Acute Hypoxemic Respiratory Failure
Abstract
Eosinophilic pneumonia (EP) refers to interstitial lung diseases characterized by pulmonary eosinophilic infiltration and elevated eosinophils in bronchoalveolar lavage (BAL) fluid with or without peripheral eosinophilia. Infliximab, an anti-TNF agent, has rarely been reported as a cause, typically acutely after starting the medication. We report a case of EP thought to be due to infliximab that occurred 6 years after starting therapy.
A 27-year-old female presented with one week history of exertional dyspnea, night sweats, and right-sided pleuritic chest pain. Her medical history was significant for pan-ulcerative colitis in remission on infliximab (last infusion one month prior). She had been on infliximab for 6 years. She denied smoking, vaping, or recent travel. On presentation, her vitals were significant for hypoxemia with oxygen saturation of 79% on room air, heart rate of 152 and respiratory rate of 24 breaths/min. She was afebrile and normotensive. Physical exam was significant for right-sided crackles. Labs showed leukocytosis (WBC 54.1 × 10³) with 88% eosinophils, CRP 117 mg/L, and negative troponins. Chest radiograph showed bilateral peripheral-predominant lower-lobe opacities with trace effusions, and computed tomography (CT) pulmonary angiography demonstrated bilateral, peripheral ground-glass nodular opacities without pulmonary embolism (Image). She was admitted to the medical intensive care unit due to requiring high-flow nasal cannula, and was empirically…
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