History : 67 year old male, non smoker, presents with over a month history of fevers, chills, anorexia and malaise despite antibiotic treatment for presumptive diagnosis of community acquired pneumonia by GP Case of the Month 7 January 2016 Case of the Month 7 What is your diagnosis? Case of the Month 7 Question: What are the key findings on this chest radiograph? Case of the Month 7 Answer: Bilateral air-space consolidation Subpleural, peripheral and upper lobe distribution Case of the Month 7 Question: What are the key findings on the CT images on lung windows? Case of the Month 7 Answer : Bilateral air-space consolidation with air-bronchograms Peripheral and subpleural Upper lobe predominant Case of the Month 7 Question: What are the key findings on the CT images on mediastinal windows? Case of the Month 7 Case of the Month Question: Bilateral hilar and mediastinal adenopathies Additional clinical information: Previously healthy except for adult onset asthma Meds: Ventolin Allergies: Ragweed WBC: 14.1 with eosinophilia 3.2 BAL: 72% eosinophils Case of the Month 7 Before treatmentAfter treatment Case of the Month 7 What is your diagnosis? Case of the Month 7 Answer: Chronic Eosinophilic Pneumonia Case of the Month 7 Idiopathic condition characterized by chronic infiltration of the lung by eosinophils Epidemiology History of asthma or atopy in 50% 90% of patients are nonsmokers (smoking may be protective) Peak incidence in 5 th decade F>M, 2:1 Chronic Eosinophilic Pneumonia Discussion Case of the Month 7 Symptoms: Insidious onset of fever, malaise, weight loss, and dry cough Labs: Peripheral blood eosinophilia Eosinophilia in bronchoalveolar lavage ~>40% (normal is