Waterpipe (narghile, hookah) tobacco smoking‑induced acute eosinophilic pneumonia

Abstract

Acute eosinophilic pneumonia (AEP) is characterized by a febrile illness, diffuse pulmonary infiltrates,hypoxemic respiratory failure, and pulmonary eosinophilia. A temporal relationship has been describedin a number of patients between the development of AEP and the recent onset of cigarette smoking.A 22‑year‑old male patient with no known chronic disease was admitted to the emergency servicefor 3 days with the complaints of cough, fever, dyspnea, and pleuritic chest pain. He was formerly anonsmoker but was a waterpipe (narghile, hookah) tobacco smoker as a new habit once a night forthe last 2 months. The erythrocyte sedimentation rate and C‑reactive protein are elevated. Arterialblood gases revealed moderate hypoxemia. Computed tomography scans included bilateral, random,and patchy ground‑glass opacities and also small bilateral pleural effusions. Echocardiograhicexamination was normal. We had accepted the patient as an acute eosinophilic pneumonia dueto rapid response to corticosteroid treatment, no microorganism in bronchoalveolar lavage (BAL)culture, and predominant eosinophilia was observed (70%–80%) in BAL.