EOSINOPHILIC PNEUMONIA AND EXTENDED-RELEASE INJECTABLE NALTREXONE

TOPIC: Lung Pathology TYPE: Medical Student/Resident Case Reports INTRODUCTION: Extended-release injectable naltrexone is an opioid antagonist approved for the treatment of alcohol and dependence. Since release drug in 2006, a literature review reveals five reported cases drug-induced eosinophilic pneumonia. Our case highlights clinical presentation pneumonia setting extended-release naltrexone. CASE PRESENTATION: A 35-year-old female with past medical history lifelong tobacco use dependence on presented to ED subjective fevers, myalgias, cough, pleuritic chest pain. She was evaluated at urgent care two days prior sent home course Levofloxacin bronchitis. Upon arrival, she noted be hypoxic placed supplemental oxygen. afebrile tachycardic. Exam pertinent tachypnea bilateral crackles. Initial laboratory data revealed WBC 19,500 (neutrophil predominate) lactic acid 1.4. Chest x-ray CT demonstrated extensive infiltrates. Empiric antibiotics were initiated while awaiting microbiology data. Due escalating oxygen requirements hemodynamic instability over next 24 hours, patient intubated bedside bronchoscopy completed. BAL studies lymphocyte predominance (46%) followed by eosinophils (27%) neutrophils (21%). Given concern acute naltrexone, corticosteroids started. Antibiotics discontinued given negative culture our showed marked improvement continuation steroid therapy. DISCUSSION: long-acting Clinical trials one diagnosed & suspected naltrexone-induced current paucity associated AEP. While etiology pathogenesis remain largely unknown, it thought related hypersensitivity reaction antigen genetically susceptible person. Progression from mild dyspnea overt respiratory failure rapid. diagnostics are often nonspecific, however pleural fluid analysis demonstrates striking eosinophilia (10%-50%) classically shows (25%-55%). Treatment includes supportive care, withdrawal any eliciting medications, glucocorticoid Most patients rapidly improve within 12-48 hours initiation corticosteroids. The prognosis excellent vast majority enjoying complete recovery. CONCLUSIONS: This rare but important association between REFERENCE #1: Korpole PR, Al-Bacha S, Hamadeh S. Biopsy: Injectable Naltrexone-Induced Acute Eosinophilic Pneumonia. Cureus. 2020;12(9):e10221. Published 2020 Sep 3. doi:10.7759/cureus.10221 #2: induced Kim H, Ali M, Buch K. http://www.atsjournals.org/doi/abs/10.1164/ajrccm-conference.2014.189.1_MeetingAbstracts.A2283 Am J Respir Crit Care Med. 2014;189:2283. #3: Saved BAL: after methyl-naltrexone injection. Esposito A, Lau B. Chest. 2019;156:2210. DISCLOSURES: No relevant relationships Kari McCoy, source=Web Response Caroline Mears, Xian Qiao,