Bronchiectasis — MCCQE Part 1 MCQ

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ModerateCoughBronchiectasisMCCQE Part 1

A 42-year-old nonsmoker with asthma has six weeks of cough, fever, weight loss and dyspnea. Eosinophils are 2.2 × 10^9/L and CT shows bilateral peripheral upper-lobe consolidations. Infection and medication causes are excluded. What is the best treatment?

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Correct answer: B — Start systemic corticosteroid therapy

Subacute constitutional and respiratory symptoms, asthma, marked eosinophilia and peripheral pulmonary consolidations are characteristic of chronic eosinophilic pneumonia. After excluding parasites, drug reactions, eosinophilic granulomatosis with polyangiitis and infection, systemic corticosteroids are the standard initial treatment and usually produce rapid clinical and radiographic improvement. Relapse is common during tapering, so treatment often continues for months and some patients need a steroid-sparing asthma biologic under specialist care. Broad antibiotics do not treat sterile eosinophilic infiltration, pleural drainage is irrelevant without an effusion, and inhaled therapy alone is inadequate for this parenchymal disease. Follow symptoms, eosinophil count, spirometry and imaging.

Reference: Acute and Chronic Eosinophilic Pneumonia review: https://pmc.ncbi.nlm.nih.gov/articles/PMC6420789/