303: Acute Eosinophilic Pneumonia ARDS: Mimicking COVID-19 in the Pandemic Era

INTRODUCTION: We present the case of a 74-year-old male with past medical history of hypertension and a left shoulder osteomyelitis by which patient was receiving home intravenous antibiotics with ceftaroline Patient presented to the emergency department due to worsening left shoulder secretions, associated shortness of breath and fever Upon arrival, pertinent images were performed and patient was found with bilateral patchy infiltrates with associated pleural effusions Upon family members interrogation patient had a recent exposure with a COVID19 infected family member Diagnosis of ceftaroline-induced AEP is based on clinical history, laboratory results, and radiographic findings, which was made METHODS: Acute eosinophilic pneumonia AEP is an acute pneumonic process that if not recognized early could result in life-threatening respiratory failure It has been described in the literature that AEP is idiopathic in most cases However, it is likely that inhalation of injurious agents such as smoke and chemicals may initiate the inflammatory cascade that characterizes this deadly disease In critical care medicine, we need to be aware of several medications well known to be associated with AEP such as Daptomycin, Azithromycin, Ceftaroline, Imipenem, Piperacillin-Tazobactam, Risperidone and many others respectively The diagnosis is commonly recognized due to imaging characteristics with a known exposure to an agent known to be associated with AEP Radiographic characteristics of AEP are bilateral ground glass areas, interlobular septal thickening, with pleural effusions to be present in the majority of the cases Eventhough, it's a deadly diagnosis sometimes are not recognized or intercalated with other conditions such as congestive heart failure The diagnosis of AEP is made via bronchoscopy by bronchioalveolar lavage Normally, eosinophils are found in very few numbers (25% eosinophils, nonspecific conditions would range between 2-25% RESULTS: Bronchoscopy was performed in the patient which reveal 42% of eosinophils, making the diagnosis in this highly suspected COVID19 patient Our point is that COVID19 could mimic multiple pulmonary etiologies, and the risks of bronchoscopy will remain a major concern in diagnostic purposes