Acute eosinophilic pneumonia and bilateral pleural effusion associated with sertraline: a case report

Acute eosinophilic pneumonia (AEP) is a rare, potentially life-threatening pulmonary disease characterized by eosinophilic infiltration of the lung parenchyma. While usually idiopathic or associated to infectious or drug-induced etiologies, sertraline-induced AEP is exceedingly uncommon. We report a case of a 25-year-old female presenting with fever, dyspnea, and hypoxemic respiratory failure following 2 months of sertraline use and recent cigarette smoking initiation. Chest imaging revealed diffuse bilateral alveolo-interstitial infiltrates and bilateral pleural effusion. Extensive microbiological and autoimmune investigations were negative. Eosinophilia was identified in bronchoalveolar lavage (BAL) and pleural fluid cytology, suggesting the diagnosis of AEP. The patient required intensive care admission with non-invasive ventilation and bilateral pleural drainage, which significantly improved respiratory parameters. Discontinuation of sertraline and initiation of systemic corticosteroid therapy resulted in rapid clinical and radiological improvement. At follow-up, the patient remained asymptomatic with complete resolution of radiographic abnormalities and normalization of pulmonary function. This case underscores the importance of detailed drug history and multidisciplinary evaluation in diagnosing AEP. The temporal association between sertraline initiation and symptom onset, combined with eosinophilic findings, supports sertraline as the likely etiologic agent. While bilateral pleural effusions are common in AEP, reports of eosinophilic pleural involvement in drug-induced forms are rare. This case highlights the need for awareness of atypical drug-related causes of AEP. Sertraline-induced AEP is a rare, potentially life-threatening but reversible condition. Timely recognition and management are critical for favorable outcomes.