(1160) Eosinophilic Pneumonia Associated With Lion’s Mane Supplementation

Introduction: Drug-induced eosinophilic pneumonia is most commonly associated with antimicrobial agents and nonsteroidal anti-inflammatory drugs. However, there have been isolated cases attributed to other medications. Identification and cessation of the offending agent is a mainstay of therapy. This is the first reported case of eosinophilic pneumonia associated with the dietary supplement, lion’s mane.

Description: A 51-year-old, non-smoking male with hypertension presented with 5 days of worsening dyspnea. He reported a non-productive cough, chills, headache, lack of appetite, and lightheadedness associated with dyspnea. Due to hypoxic respiratory failure requiring high flow nasal cannula the patient was admitted to the intensive care unit. Labs were remarkable for elevated serum eosinophil count. Computed tomography of the chest with angiography revealed non-specific, diffuse, upper lung predominant mixed interstitial and airspace disease without evidence of pulmonary embolism. The patient was initiated on antimicrobial therapy for the treatment of community acquired pneumonia. Bronchoscopy with bronchoalveolar lavage was performed and was remarkable for a sputum cell count differential of 41% eosinophils. The patient denied inhalation exposures. The patient reported starting a new oral supplement, Hericium erinaceus, commonly known as lion’s mane, 11 days prior to admission. For the diagnosis of eosinophilic pneumonia high dose corticosteroids were initiated. Infectious evaluation including cultures from bronchoalveolar lavage were unremarkable and antimicrobials were discontinued. Oxygen was rapidly weaned, and the patient was discharged on room air with an oral prednisone taper for the treatment of eosinophilic pneumonia with outpatient pulmonary follow-up.

Discussion: This is the first reported case of eosinophilic pneumonia associated with lion’s mane supplement. This case highlights the importance of evaluating exposure to over-the-counter supplements as a potential offending agent that should be discontinued as part of the management of eosinophilic pneumonia.