Abstract
Acute eosinophilic pneumonia (AEP) is characterized by idiopathic acute febrile illness, diffuse pulmonary infiltration, severe hypoxemia, and pulmonary eosinophilia. We report a case of AEP associated with intramuscular administration of progesterone as luteal phase support after in vitro fertilization. A 33-year-old woman presented to our emergency room with tachypnea and hypoxemia, complaining of fever and cough for 4 days, and dyspnea for 2 days. The symptoms began 9 days after the first injection of progesterone. Chest radiograph showed bilateral infiltrates, located predominantly in the periphery of the lungs, with blunting of the costophrenic angle. Symptoms and chest radiograph dramatically improved after corticosteroid therapy and shifting the progesterone from an intramuscular form of administration to a vaginal form of administration.
References
1. Allen JN, Pacht ER, Gadek JE, Davis WB. Acute eosinophilic pneumonia as a reversible cause of noninfectious respiratory failure. N Engl J Med. 1989. 321:569–574.
2. Allen JN, Davis WB. Eosinophilic lung diseases. Am J Respir Crit Care Med. 1994. 150:1423–1438.
3. Bouckaert Y, Robert F, Englert Y, De Backer D, De Vuyst P, Delbaere A. Acute eosinophilic pneumonia associated with intramuscular administration of progesterone as luteal phase support after IVF: case report. Hum Reprod. 2004. 19:1806–1810.
4. Khan AM, Jariwala S, Lieman HJ, Klapper P. Acute eosinophilic pneumonia with intramuscular progesterone after in vitro fertilization. Fertil Steril. 2008. 90:1200.e3–1200.e6.
5. Phy JL, Weiss WT, Weiler CR, Damario MA. Hypersensitivity to progesterone-in-oil after in vitro fertilization and embryo transfer. Fertil Steril. 2003. 80:1272–1275.
6. Veysman B, Vlahos I, Oshva L. Pneumonitis and eosinophilia after in vitro fertilization treatment. Ann Emerg Med. 2006. 47:472–475.
7. Crofton JW, Livingstone JL, Oswald NC, Roberts AT. Pulmonary eosinophilia. Thorax. 1952. 7:1–35.
8. Carrington CB, Addington WW, Goff AM, Madoff IM, Marks A, Schwaber JR, et al. Chronic eosinophilic pneumonia. N Engl J Med. 1969. 280:787–798.
9. Badesch DB, King TE Jr, Schwarz MI. Acute eosinophilic pneumonia: a hypersensitivity phenomenon? Am Rev Respir Dis. 1989. 139:249–252.
10. Pope-Harman AL, Davis WB, Allen ED, Christoforidis AJ, Allen JN. Acute eosinophilic pneumonia: a summary of 15 cases and review of the literature. Medicine (Baltimore). 1996. 75:334–342.
11. Smitz J, Devroey P, Camus M, Deschacht J, Khan I, Staessen C, et al. The luteal phase and early pregnancy after combined GnRH-agonist/HMG treatment for superovulation in IVF or GIFT. Hum Reprod. 1988. 3:585–590.
12. Soliman S, Daya S, Collins J, Hughes EG. The role of luteal phase support in infertility treatment: a metaanalysis of randomized trials. Fertil Steril. 1994. 61:1068–1076.