CHEST Guidelines-Pulmonary-Eosinophilia-From-Inhaled-Colistin

Pulmonary-Eosinophilia-From-Inhaled-Colistin_chest

Pdf Summary

The document presents a case report of an 83-year-old woman with chronic bronchiectasis who developed pulmonary eosinophilia from inhaled colistimethate sodium. The patient presented with new-onset fatigue, shortness of breath, peripheral blood eosinophilia, and infiltrates on a chest radiograph. Despite discontinuing the drug, symptoms and peripheral eosinophilia persisted. After starting oral prednisone, her condition improved within 48 hours.<br /><br />The patient's history includes pulmonary tuberculosis, colonization with Pseudomonas aeruginosa, and numerous comorbidities such as hypertension, hyperlipidemia, and type 2 diabetes mellitus. Several previous drug-related adverse reactions were also documented, including a skin rash from penicillin and bronchospasm due to tobramycin. <br /><br />After starting inhaled colistimethate sodium, the patient experienced respiratory symptoms within days. Chest imaging revealed new alveolar infiltrates and a CT scan indicated a crazy paving pattern, suggesting pulmonary eosinophilia. Examination and tests ruled out other causes, confirming the adverse reaction to colistin. The patient was treated with oral corticosteroids, resulting in rapid improvement and no recurrence of symptoms over a 6-month follow-up.<br /><br />Though colistin is considered effective against Pseudomonas aeruginosa in chronic bronchiectasis, it has been linked to rare cases of lung toxicity. This case highlights the first reported instance of eosinophilic lung reaction due to inhaled colistimethate and emphasizes the importance for clinicians to be aware of this potential adverse effect. Proper preparation and timely usage of the drug are advised to prevent toxicity.<br /><br />The case underscores the need for awareness of side effects associated with inhaled colistin, despite its efficacy in treating respiratory infections, as well as the beneficial role of corticosteroids in managing drug-induced pulmonary eosinophilia.

Keywords

pulmonary eosinophilia

chronic bronchiectasis

colistimethate sodium

adverse drug reaction

Pseudomonas aeruginosa

oral prednisone

corticosteroids

lung toxicity

respiratory infections

drug-induced eosinophilia