CTICasesNaltrexone (Vivitrol)-Induced Acute Eosinophilic Pneumonia
Imaging findings
A patient presenting to the emergency department with shortness of breath had a chest radiograph with subtly abnormal lungs and a CT showing extensive diffuse multilobar confluent ground-glass opacity with a lesser degree of consolidation, without pulmonary embolism. Laboratory workup showed peripheral eosinophilia (9.5%) and marked eosinophilia on bronchoalveolar lavage (70%), and the patient had recently been started on naltrexone (Vivitrol); the opacities resolved on follow-up imaging after the drug was stopped and steroids were given.
Key takeaways
Naltrexone/Vivitrol, an opioid antagonist used to reduce cravings in substance use disorder, is a recognized rare cause of acute eosinophilic pneumonia, and a compatible clinical picture of diffuse ground-glass opacity with peripheral and bronchoalveolar lavage eosinophilia in a patient on this drug should prompt drug cessation and steroid treatment, with an expectation of resolution on imaging.
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