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Acute Eosinophilic Pneumonia - A Medical Problem from the War in Iraq?

Unexplained respiratory failure in military personnel stationed in or near Iraq? Consider acute eosinophilic pneumonia.

The major medical problems for U.S. military personnel stationed in or near Iraq have been trauma-related. However, in mid-2003, 10 cases of acute eosinophilic pneumonia (AEP) were identified in apparently healthy military personnel. Now, U.S. Army researchers have provided data on 18 cases of AEP that occurred between March 2003 and March 2004 among the 183,000 military personnel stationed in the area.

By definition, the AEP patients all had an acute febrile illness with X-ray evidence of diffuse pulmonary infiltrates. Seven cases, diagnosed by lung biopsy or bronchoalveolar lavage, were categorized as definite AEP; 11 others were categorized as probable AEP based on the development of peripheral eosinophilia. Median age was 22 (range, 19-47), and time from arrival in the area to illness onset varied from 1 day to 11 months. Median time between symptom onset and presentation for medical care was 1 day (range, 1-4 days). Twelve patients required mechanical ventilation, and 2 died. In all patients, hepatic and renal functions were normal, and evaluation for known infectious and noninfectious causes of AEP was unrevealing. All patients received antibiotic therapy, and 14 also received corticosteroids. No evidence was seen of common-source exposure or of person-to-person transmission. An unusually high proportion of these patients were smokers (100%, vs. 67% in a cohort of U.S. military personnel without AEP) and new-onset smokers (78% vs. 3%). However, they smoked a variety of cigarette brands, and an evaluation of both local and U.S. tobacco products available in the area found no unusual components.

Comment: AEP incidence among U.S. military personnel stationed in or near Iraq during this period was a remarkable 9.1 per 100,000 person-years. Despite aggressive diagnostic evaluations, the etiology of the illness remains undefined. Clinicians should consider this diagnosis in individuals presenting with unexplained respiratory failure during or shortly after travel to the region.

— Richard T. Ellison III, MD

Published in Journal Watch Infectious Diseases January 31, 2005

Citation(s):

Shorr AF et al. Acute eosinophilic pneumonia among US military personnel deployed in or near Iraq. JAMA 2004 Dec 22; 292:2997-3005.

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