Imipramine Pulmonary eosinophilia

A 36-year-old woman with a 4-year history of major melancholic depression refractory to other antidepressant drugs, Stein-Leventhal syndrome treated surgically, childhood asthma and multiple drug allergies was given imipramine increased gradually to 200 mg/day by day 13. She had previously been drug­free for > 4 weeks and on starting imipramine therapy had normal physical and laboratory examinations.

A minimal dry cough had developed after 7 days of treatment and, after 13 days, dyspnoea and a dry cough. She was afebrile with clear lungs and Imipramine was continued for 14 days (serum level of imipramine + desmethylimlpramlne 159 ng/ ml). On day 28, the dose was increased to 300 mg/ day and the cough and dyspnoea worsened . On day 30, the eosinophil count was 26% with haemoglobin 16.8 g/dl and haematocrit 48.9% . She had a decreased FEV 1 (64%), maximum voluntary ventilation (66% of predicted ), and mid -expiratory flow rate (42% of predicted). ECG showed an abnormal right axis deviation with abnormal QRS and RSR ' complexes, and a minimal diffuse infiltration pattern was seen in the peripheral lung fields.

Imipramine was quickly tapered and withdrawn on day 32. Cough and dyspnoea had improved by day 36 and the eOSinophilia decreased to 7% . All pulmonary symptoms had resolved by day 46, phenelzine was administered , and the eosinophil count decreased to 2% over the next 4 weeks , remaining normal for a year.

Loeffler's syndrome, or simple pulmonary eosinophilia, is an allergic reaction rarely associated with tr icyclic antidepressants . Although bone marrow aspiration or tests for parasitic helminths were not performed, the pulmonary symptoms and previous history of asthma and drug allergies ' . .. suggested a strong presumptive diagnosis of LS [Loeffler's syndrome] in this patient'. Amslerdam JO. Inlerna"onal Cllmcal Psychopharmacology 1 260·262. Jul 1986

0157-7271 / 86/ 1004-0009/ 0$01.00/ 0 © ADIS Press Reactions® 4 Oct 1986 9