Pulmonary Eosinophilia Secondary to Topiramate Use

SESSION TITLE: Fellow Case Report Poster - Diffuse Lung Disease I SESSION TYPE: Affiliate Case Report Poster PRESENTED ON: Tuesday, October 25, 2016 at 01:30 PM - 02:30 PM INTRODUCTION: Pulmonary eosinophilia is a broad category of diseases involving an increase in eosinophilia in the lung parenchyma or airways. Various drugs are known to cause pulmonary eosinophilia. We present a case of pulmonary eosinophilia precipitated by the use of topiramate. CASE PRESENTATION: The patient is a 52 year old female with history of insomnia who presents with three days of subjective fevers, cough, and dyspnea. She went to a clinic where she was found to by hypoxic and was referred to the emergency room. About two weeks prior to presentation the patient started taking topiramate for insomnia. In the emergency room her vitals were notable for fever and an oxygen saturation of 85%. Blood worked showed a leukocytosis of 15.4 thousand cells per microliter and an absolute eosinophil count of 1100 cells per microliter. Her chest x-ray showed diffuse patchy airspace opacities and interstitial markings. A chest CT showed diffuse ground glass opacities and interlobular septal thickening. The patient underwent bronchoscopy. The cell count from the bronchoalveolar lavage had 18% eosinophils. Transbronchial biopsy showed inflammatory cells with numerous eosinophils. The patient was started on prednisone 1 mg/kg daily. The patient’s symptoms quickly resolved. A repeat chest x-ray taken two days after starting prednisone showed significant improvement. DISCUSSION: The clinical presentation is consistent with a drug induced pulmonary eosinophilia due to topiramate. The patient responded to discontinuation of the medication and steroids. Her chest X-ray improved significantly after initiation of steroids. To date we have not been able to find any prior case reports of topiramate causing pulmonary eosinophilia. The necessity of steroids in the treatment of drug induced pulmonary eosinophilia is unclear. Cessation of the drug may be sufficient treatment. CONCLUSIONS: In the evaluation of pulmonary eosinophilia the patient’s medication history should be thoroughly evaluated. Topiramate should be considered as a drug that can cause pulmonary eosinophilia and can be treated with discontinuing the drug and initiation of steroids Reference #1: Hashimoto, N., Maeda, T., Okubo, R., Narita, H., Kusumi, I. 2015. Simple Pulmonary Eosinophilia Associated with Clozapine Treatment. J Clin Psychopharmacol. 35: 99-101. Reference #2: Salerno, S.M., Strong, J.S., Roth, B.J., and Sakata, V. 1995. Eosinophilic Pneumonia and Respiratory Failure Associated with a Trazodone Overdose. Am J Respir Crit Care Med. 152: 2170-2. DISCLOSURE: The following authors have nothing to disclose: Ray Pillai, Kathleen Doo, Nishay Chitkara No Product/Research Disclosure Information