Abstract Introduction Chronic eosinophilic pneumonia (CEP) is an uncommon interstitial lung disease characterized by respiratory symptoms, peripheral eosinophilia, and characteristic radiographic findings of peripheral or upper lobe opacities. Although most cases are idiopathic, CEP may occasionally be triggered by medications, infections, or inhalational exposures. Association with recreational marijuana use is rare but increasingly relevant given rising use. We report a case of marijuana-associated CEP that resolved completely with cessation alone. Case A 33-year-old woman with no known comorbidities presented to our center with 3 months of progressive dyspnea and a cough productive of thick green sputum. She denied any occupational or tobacco exposure but reported that she smoked marijuana daily due to her anxiety disorder. Initial laboratory studies showed peripheral hypereosinophilia of 7590, elevated IgE of 5139 and CT findings of right upper lobe ground glass opacities along with bilateral lower lobe septal thickening with nodularity. An extensive autoimmune work up was done which was largely unremarkable. Bronchoscopy with biopsy was done which showed 34% eosinophils, and pathology positive for eosinophilic pneumonia and changes consistent with organizing pneumonia with some granulomatous inflammation. The patient was then advised to stop marijuana smoking and was followed up in the pulmonary clinic. Her clinical symptoms and CT findings eventually resolved with marijuana cessation without any additional treatment including steroids, suggesting marijuana as the cause of her eosinophilic pneumonia. Discussion CEP is part of a group of eosinophilic lung diseases characterized by abnormal accumulation of eosinophils in the lung tissue. Cannabis smoke can provoke eosinophilic inflammation through airway epithelial injury, immune activation, and the release of inflammatory mediators that attract eosinophils. Repeated exposure can cause structural airway changes and immune dysregulation, creating a milieu favorable to eosinophilic infiltration. While corticosteroids are typically the mainstay of treatment, removal of the inciting agent alone may be sufficient for resolution, as demonstrated in this case. Early recognition of marijuana-associated CEP is critical to prevent unnecessary immunosuppression, reduce the risk of relapse, and guide appropriate follow-up and monitoring. Clinicians should consider inhalational exposures when evaluating patients with pulmonary eosinophilia, particularly in younger adults without other risk factors. This abstract is funded by: None
Javed et al. (Fri,) studied this question.