Source: Annual Congress 2002 - Asthma: Inflammation, hyperreactivity, treatment side effects

Abstract

A 42-year old woman with an 8-year history of asthma required frequent use of systemic corticosteroids. Addition of montelukast in Dec. 1998 resulted in persistent alleviation of her asthma. No systemic steroids were used in this period. In june 1999, because of cutaneous manifestations, montelukast was replaced by zafirlukast at a higher dose. One month later the patient developed cough, dyspnoea and fever. Admitted to hospital, a chest radiograph showed bilateral alveolar interstitial infiltrates. Laboratory findings were a WBC count of 29.0 x 10E9 /L with an eosinophil fraction of 41%. The total IgE level was 1925. BAL contained 80% eosinophils and TBB revealed eosinophil infiltration of alveoli and septa without definite signs of vasculitis. Zafirlukast was discontinued and methylprednisolone i.v. at a dose of 80 mg/daily was begun. Symptoms and radiographic findings improved rapidly. Corticosteroid treatment was discontinued after 40 days. Twenty days later a new episode of eosinophilic pneumonia required readmission to hospital despite no antileukotriene therapy being administered at that time. Systemic steroid treatment again induced a rapid recovery and no other episodes occurred in 18 months of observation after discontinuation of steroids.
Considerations: the type and/or dose of antileukotrienes could have played a causative role in the onset of the eosinophilic pneumonia, which developed after substituting montelukast with zafirlukast at a higher dose. On the other hand, the recurrence after withdrawing steroids and without the reintroduction of antileukotrienes strengthens the hypotesis that the eosinophilic pneumonia was more probably related to the absence of steroids than to the action of antileukotrienes.

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P. Cremaschi, C. Catanese, G. Terzuolo, S. Rizzo, O. Filieri, A. Rossi (Pavia, Italy). Recurrent eosinophilic pneumonia in an asthmatic patient treated with sequential montelukast/zafirlukast after corticosteroid withdrawal. Eur Respir J 2002; 20: Suppl. 38, 435

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