Eosinophilic pneumonia and pulmonary aspergillosis each make up a clinical spectrum that may overlap and be difficult to differentiate. Corticosteroids are the mainstay of treatment in noninvasive disease. We describe a fatal case of invasive pulmonary aspergillosis presenting as an eosinophilic pneumonia treated with corticosteroids.
An 11-year-old boy was seen by his physician because of dyspnea, fever, and cough. A chest roentgenogram showed diffuse infiltrates. He was hospitalized and treated with intravenous erythromycin, but was transferred to Childrens Hospital of Pittsburgh because of progressive dyspnea.
There was no history of wheezing or asthma in the patient or family members. The patient had played with his two siblings in a compost pile 8 h before his symptoms developed.
He was a white boy in respiratory distress with suprasternal and intercostal retractions. The temperature was 38.5°C; the respiratory rate, 6Q/min; the heart rate, 128/min; and the blood pressure, 110/ 56 mm Hg. On auscultation of the chest, there were no adventitious sounds.
The white blood cell count was 15,300/cu mm with 87 percent neutrophils, 2 percent band forms, 2 percent lymphocytes, 1 percent monocytes, and 8 percent eosinophils.