Eosinophilic Granuloma of the Lung

Eosinophilic granuloma limited to the lung was first described in 1951 when Farinacci7 reported two patients diagnosed by lung biopsy. Since then, 14 more cases have been reported: five by Arnett and Schulz,’ three by Auld,2 two by Mazzitello,’9 and single cases by Virshup and Goldman,26 Thompson,25 Livingston,1’ and Kaunitz.1’ It is our purpose to add two cases of our own and briefly review the literature. Case 1. A 38 year-old white woman was first seen in September, 1955 with a ninemonth history of coughing which was productive of one half cup of clear sputum daily. There was no other symptom. Physical examination was essentially normal. A chest roentgenogram demonstrated diffuse bilateral nodular infiltration with evidence of fibrosis and emphysema (Fig. 1). The hemogram and urinalysis were normal. There was no eosinophilia. Pulmonary function studies were normal. A lung biopsy was accomplished with a preoperative impression of sarcoidosis. No pleural adhesions or subpleural blebs were present. No mediastinal adenopathy was noted. Multiple 2 to 4 mm. nodules were present throughout the lung parenchyma. The pathological diagnosis was eosinophilic granuloma (Fig. 2). Only general supportive treatment was given, but her family doctor reported that she was completely recovered two months after surgery and has remained well. Case 2: A 37 year-old white woman was first seen in November, 1957, with a fivemonth history of malaise, slight weight loss, and low-grade fever. She had been treated with broad spectrum antibiotics without improvement. She developed vague anterior chest pain, but had no cough or night sweats. Physical examination was essentially normal. A chest roentgenogram showed a diffuse nodular bilateral infiltrate similar to that in Case 1. The hemogram was normal and eosinophils ranged from 0-3 per cent. Laboratory examinations, including stool studies for parasites and tuberculosis smears and cultures, were negative. Scalene lymph node biopsy was negative. A right pulmonary biopsy was performed and the findings and diagnosis were essentially similar to Case 1. No specific treatment was instituted, but she became asymptomatic. Over a period of six months, the x-ray appearance of the lungs gradually improved.