Idiopathic Chronic Eosinophilic pneumonia: A Rare Pediatric Interstitial Lung Disease with Diagnostic Challenges

Abstract

Background: Idiopathic chronic eosinophilic pneumonia (ICEP) is an uncommon cause of chronic respiratory illness in children and often presents a diagnostic challenge, particularly in tuberculosis-endemic regions. Case Presentation: We report the case of a 4-year-old male who presented with chronic cough, exertional dyspnea, fever, weight loss, and persistent right middle lobe opacity on imaging for one year. Initial differential diagnoses included asthma, tuberculosis, and community-acquired pneumonia. Investigations: Radiological evaluation revealed persistent middle lobe consolidation with bilateral diffuse ground-glass opacities. Bronchoscopy with bronchoalveolar lavage (BAL) demonstrated marked eosinophilia (60%), confirming eosinophilic lung disease. Investigations for tuberculosis, cystic fibrosis, primary immunodeficiency, parasitic infection, and other secondary causes of eosinophilic lung disease were negative. Management and Outcome: Oral prednisolone was initiated at 1 mg/kg/day, resulting in rapid clinical and radiological improvement within 7 days. The patient has remained asymptomatic for four months following diagnosis while steroids are being gradually tapered. Conclusion: Idiopathic chronic eosinophilic pneumonia in children requires a high index of suspicion, especially when chronic respiratory symptoms persist despite standard therapy. Bronchoscopy with BAL is critical for diagnosis, while radiological findings, though supportive, may be atypical. Early recognition and corticosteroid therapy lead to excellent clinical outcomes, underscoring the importance of timely diagnosis to prevent prolonged mismanagement.

Medivision J. of Med. and Health Sci. Vol 1(1), Jul 2026; p 88-92