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Loffler's syndrome (simple pulmonary eosinophilia)

Transient pulmonary infiltrates with eosinophilia. Etiology: 1) helminth infection - schistosomiasis, trichinosis, filariasis, toxocariasis, Ascaris 2) pharmaceutical agents 3) idiopathic Epidemiology: - travel to developing country [3] - rare & generally occurs in individuals previously exposed to Ascaris antigens Pathology: - parasitic (helminths) 1) migration of nematode larvae through the lungs where they mature in the alveolar capillary bed 2) from there, they enter the alveoli & are carried by respiratory clearance mechanisms to the epiglottis where they are swallowed to regain access to the intestines 3) arteritis may cause endocarditis, severe endocardial scarring, with negligible fibroelastosis Clinical manifestations: 1) bilateral, diffuse, mottled pulmonary infiltrates 2) mild bronchitis - dry cough - wheezing Laboratory: - complete blood count - eosinophilia - anemia may be present - serology for infectious agents - stool for ova & parasites Radiology: - chest X-ray: transient bilateral pulmonary infiltrates Complications: - Loffler's endocarditis commonly with thromboembolism, including embolic stroke Differential diagnosis: - tuberculosis: - radiographic pulmonary infiltrates are not transient - eosinophilia not common Notes: - distinguish from Lofgren's syndrome

Related

helminth infection Lofgren's syndrome

General

pulmonary infiltrates with eosinophilia (PIE) syndrome

References

  1. Clinical Diagnosis & Management by Laboratory Methods, 19th edition, J.B. Henry (ed), W.B. Saunders Co., Philadelphia, PA. 1996, pg 1285
  2. Medical Knowledge Self Assessment Program (MKSAP) 11, American College of Physicians, Philadelphia 1998
  3. NEJM Knowledge+ Complex Medical Care