Hypoxic eosinophilic pneumonia in two patients given ACE inhibitors.

Diffuse hypoxic pneumonia was found to be caused by angiotensin converting enzyme (ACE) inhibitors in two patients given enalapril and fosinopril for hypertension. Both patients developed sub-acute respiratory failure and los t weight. Imaging explorations showed multiple areas of alveolar consolidat ion, mode-rate pleural effusion and in one case linear opacities. In both c ases, peripheral eosinophila was found and the bronchoalveolar lavage fluid contained lymphocytes. Progressive improvement was achieved after withdrawal of the ACE and cortic osteroid therapy for three months. Subsequent x-rays and respiratory functi on tests returned to normal apart from persistently low CO diffusion in one patient. In view of other cases reported in the literature, ACE inhibitors should pr obably be included in the list of drugs capable of inducing pneumonia, nota bly eosinophilic pneumonia.