IDIOPATSKI EOZINOFILNI PLEURALNI IZLJEV – PRIKAZ BOLESNIKA

Joško Mitrović, Branimir Anić, Jadranka Morović Vergles

Eozinofilni pleuralni izljev (EPI) ubrajamo u skupinu eksudativnih izljeva. Označava ga prisutnost od najmanje 10% eozinofilnih granulocita u pleuralnoj tekućini.¹ Najčešća stanja povezana s EPI jesu maligne bolesti, infekcije, postkirurška i posttraumatska stanja, hipersenzitivnost, sistemske autoimunosne bolesti, srčana dekompenzacija, ciroza jetre, plućna embolija, azbestoza i reakcija na lijekove.^2–4 U sistemskim autoimunosnim bolestima pleuralni se izljev najčešće nalazi u bolesnika sa sistemskim eritemskim lupusom^5,6 i reumatoidnim artritisom,⁶ a rjeđe u sistemskoj sklerozi i polimiozitisu⁶ dok je iznimno rijedak u Churg-Straussovu sindromu.⁷ U 14 do 25% bolesnika uzrok EPI ostaje nepoznat i tada EPI nazivamo idiopatskim.^2–4 Liječenje EPI zasniva se na liječenju primarne bolesti, a idiopatski oblik liječi se primjenom glukokortikoida. U radu smo prikazali bolesnika s idiopatskim eozinofilnim pleuralnim izljevom i dijagnostički postupak kojim su isključene druge bolesti ili stanja te liječenje metilprednizolonom koje je dalo odličan klinički odgovor uz izlječenje.

Eosinophilic pleural effusion (EPE) is defined as exudative effusion that contains at least 10% eosinophils.¹ The most common conditions associated with EPE are malignancy, infections, post-traumatic and post-surgical conditions, hypersensitivity, systemic autoimmune diseases, congestive heart failure, cirrhosis, pulmonary embolus, asbestosis and drug induced EPE.^2–4 Pleural effusion accompanying autoimmune diseases is most common in patients with systemic lupus erythematosus,^5,6 rheumatoid arthritis,⁶ howewer it rarely occurs in patients with progressive systemic sclerosis and polymiositis.⁶ EPE has rarely been reported in association with Churg Strauss syndrome.⁷ In about 14–25% of patients EPE can be defined as idiopathic when diagnostic procedures failed to identify the etiology.^2–4 Treatment of EPE is based on the treatment of primary disease and with idiopathic form a good answer is reached using glucocorticoids. In this case report we presented the patient with idiopathic eosinophilic pleural effusion where in diagnostic procedures we excluded other diseases or conditions in which EPE can be shown, and with applied therapy with methylprednisolone we achieved excellent clinical response and final healing.