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Shorr AF, Scoville SL, Cersovsky SB, et al. Acute Eosinophilic Pneumonia Among US Military Personnel Deployed in or Near Iraq. JAMA. 2004;292(24):2997–3005. doi:10.1001/jama.292.24.2997
Author Affiliations: Pulmonary, Critical Care,
& Sleep Medicine Service (Dr Shorr) and Allergy and Immunology Service
(Dr Carr), Walter Reed Army Medical Center, Washington, DC; US Army Center
for Health Promotion and Preventive Medicine, Aberdeen Proving Ground, Md
(Drs Cersovsky, Scoville, Shanks, and Petruccelli); and Departments of Communicable
Diseases and Immunology (Dr Ockenhouse) and Preventive Medicine (Dr Smoak),
Walter Reed Army Institute of Research, Silver Spring, Md.
Context Acute eosinophilic pneumonia (AEP) is a rare disease of unknown etiology
characterized by respiratory failure, radiographic infiltrates, and eosinophilic
infiltration of the lung.
Objectives To describe a case series of AEP, illustrate the clinical features of
this syndrome, and report the results of an epidemiologic investigation.
Design, Setting, and Participants Epidemiologic investigation of cases of AEP identified both retrospectively
and prospectively from March 2003 through March 2004 among US military personnel
deployed in or near Iraq. Survivors were offered a follow-up evaluation.
Main Outcome Measure Morbidity and mortality related to AEP.
Results There were 18 cases of AEP identified among 183 000 military personnel
deployed in or near Iraq during the study period, yielding an AEP incidence
of 9.1 per 100 000 person-years (95% confidence interval, 4.3-13.3).
The majority of patients (89%) were men and the median age was 22 (range,
19-47) years. All patients used tobacco, with 78% recently beginning to smoke.
All but 1 reported significant exposure to fine airborne sand or dust. Known
causes of pulmonary eosinophilia (eg, drug exposures or parasitic disease)
were not identified. Epidemiologic investigation revealed no evidence of a
common source exposure, temporal or geographic clustering, person-to-person
transmission, or an association with recent vaccination. Six patients underwent
bronchoalveolar lavage (median eosinophilia of 40.5%). All patients developed
peripheral eosinophilia (range, 8%-42%). Mechanical ventilation was required
in 67% for a median of 7 (range, 2-16) days. Two soldiers died; the remainder
responded to corticosteroids and/or supportive care. Twelve individuals were
reevaluated a median of 3 months after diagnosis. At that point, 3 patients
reported mild dyspnea and 1 reported wheezing. All patients had finished treatment
and had either normal or nearly normal spirometry results. None had recurrent
Conclusions AEP occurred at an increased rate among this deployed military population
and resulted in 2 deaths. Failure to consider AEP in the differential diagnosis
of respiratory failure in military personnel can result in missing this syndrome
and possibly death. The etiology of AEP remains unclear, but the association
with new-onset smoking suggests a possible link.
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