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Drug-induced eosinophilic pneumonia — SCE Respiratory MCQ

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HardInterstitial Lung DiseaseDrug-induced eosinophilic pneumoniaSCE Respiratory

A 43-year-old man with inflammatory bowel disease treated with mesalazine develops cough, fever and dyspnoea. CT shows bilateral peripheral consolidations and ground-glass opacities. Blood eosinophils are 1.9 x 10^9/L and BAL eosinophils are high. Symptoms improve after stopping mesalazine and corticosteroids. What is the most likely diagnosis?

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Correct answer: C — Drug-induced eosinophilic pneumonia

The best answer is “Drug-induced eosinophilic pneumonia”. The clinical pattern, physiology and imaging described are most consistent with Drug-induced eosinophilic pneumonia. The competing diagnoses may share individual findings, but do not account for the complete combination in the stem. The remaining choices—“Idiopathic pulmonary fibrosis”, “Pulmonary oedema, after safety review”, “Small-cell lung cancer”, “Chronic thromboembolic disease”—are credible in related respiratory presentations, but each addresses a different diagnostic, staging or management decision and does not fit the decisive findings and pathway position in this stem.

Reference: British Thoracic Society clinical statement on pulmonary eosinophilia: https://thorax.bmj.com/content/76/Suppl_1/s1