Finally, we discuss the percentage of these 178 subjects that pre

Finally, we discuss the percentage of these 178 subjects that presented with an increase of eosinophils in peripheral blood and BALF. A 70-year-old woman, who has had a diagnosis of sarcoidosis since she was 38 years old, was admitted to our hospital in October 2008.

She had been followed without treatment after the initial diagnosis, but she developed cough and dyspnea in September 2008. She had never smoked Selleck Adriamycin and had no apparent history of exposure to allergens, had not been exposed to environmental changes, and had not used new medicines or dietary supplements for at least 6 months before admission. She had no history of any allergic diseases, such as bronchial asthma, allergic rhinitis, or atopic dermatitis. She lived in an urban area and had never traveled to areas with a high prevalence of parasites. Laboratory data revealed increases in peripheral eosinophil counts (10.0%, 869/μL), total serum IgE levels [509.3 IU/L (normal: 0–295)],

serum angiotensin converting enzyme (ACE) activity [33.5 IU/L (normal: 8.3–21.5)], and soluble interleukin-2 receptor (sIL2R) [3932 U/mL (normal: 0–459)] relative to data from three months before (eosinophil: 5.0%, 330/μL, ACE: 23.2 IU/L). The results of IgE multiple antigen simultaneous tests revealed positive for Dermatophagoides farinae and negative for Aspergillus. She was also negative for antineutrophil cytoplasmic antibodies to both myeloperoxidase and proteinase 3. No evidence of parasites were found in stool samples. High-resolution computed tomography (CT) revealed diffuse ground-glass opacity in the bilateral middle and lower lobe, and enlargement of bilateral JAK inhibitor hilar and mediastinal lymph nodes. Analysis of BALF obtained from the right S4+5 segment

revealed elevated eosinophil (15.2%) and lymphocyte (51.2%) counts and a high CD4/8 ratio (26.2), but no evidence of microbial culture. Lung biopsy revealed infiltration of eosinophils in alveolar walls and alveolar spaces ( Fig 1a) with granulomatous tissue containing multinucleated giant cells ( Fig 1b), but no evidence of angiitis. Transbronchial needle biopsy from the #7 lymph node also revealed non-caseating epithelioid cell granuloma ( Fig. 1c) with no apparent pathogens, such as fungus or mycobacterium. Eosinophilic pneumonia accompanied by sarcoidosis was suspected. Her respiratory symptoms, 4-Aminobutyrate aminotransferase the ground-glass opacities by chest X-ray and peripheral eosinophilia, elevated serum ACE activity and sIL2R remitted spontaneously without treatment within several months. When her clinical course was evaluated retrospectively, it became evident that she had had a similar episode in 2004; at that time, she had developed a mild cough, ground-glass opacities in the lower lobe of the left lung, peripheral eosinophilia, and elevated serum ACE activity ( Fig. 2). All these symptoms remitted spontaneously within several months without treatment.

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