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ANSWER

This patient history suggests appears to have an exposure related disease. For this reason it was felt to be prudent to recommend a change of school environment so the patient has changed school. Public Health was contacted to assess the school environment. They elected not to carry out testing for possible contaminants as it is expensive, the results can be misleading and we had no strong evidence that a specific antigen should be sought.

TREATMENT

The patient was commenced on prednisone 1mg/kg/day for 1 week and then a weaning regime was planned weaned over 3 months to a dose of 2.5mg alternate days. The patient was seen for follow up after 3 weeks. At this time he was much improved clinically.

Here is his follow up chest radiograph showing normalization of the lung fields.

ENLARGE this chest Xray.

At 6 weeks follow up a limited High Resolution CT was performed. There is complete normalization of his previous disease with no evidence of fibrosis.

Enlarge the CT on the LEFT, enlarge the CT on the RIGHT.

CONCLUSION

The most likely diagnosis in this 10-year-old boy is chronic eosinophilic pneumonia. He has had a dramatic response to treatment and is currently doing well. His prognosis is uncertain. He may well require prolonged corticosteroid treatment and will require close follow up.

Bibliography on the next page.


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