Acute pulmonary eosinophilia (Loeffler s syndrome)

Saturday, 08 November 2008 08:22

Acute pulmonary eosinophilia (Loeffler's syndrome)
Causes and Risks:
Causes may include exposure to various drugs, parasitic infestation (especially ascariasis in children), nickel exposure, recent blood transfusion, or lymphangiogram . Often, the cause remains undetermined, although a response by the immune system to a sensitizing antigen is suspected. Lung infiltrates show a large amount of eosinophils , a type of white blood cell. The incidence is 6 out of 100,000 people.

Prevention:
This is a rare disorder. Many times, the cause is unknown. Minimizing exposure to possible risk factors (nickle, drugs, and so on) may reduce the risk.

Symptoms:

general ill feeling ( malaise )
loss of appetite
fever lasting 2 to 3 days
cough that is productive of mucus-like phlegm (mucoid sputum)
chest pain
shortness of breath
wheezing
rapid respiratory rate
headache
muscle pain
Note: Symptoms may be mild, severe, or not present. Symptoms will usually resolve spontaneously.

Signs and Tests:
Listening to the chest with a stethoscope ( auscultation ) reveals fluid in the lungs, and may reveal a friction rub.

A bronchoscopy shows hypersensitivity reaction .
An open lung biopsy shows hypersensitivity reaction.
A CBC or WBC count shows increased white blood cells, particularly eosinophils . The blood differential may also be abnormal.
These tests also confirm the diagnosis:

sputum smear (KOH test)
chest X-ray
Complications:
severe pneumonia

Simple pulmonary eosinophilia (Loeffler syndrome) with peripheral eosinophilia (53.5% of eosinophils in the peripheral blood). Thin-section CT shows multiple small nodules (arrows) with a surrounding halo of ground glass opacity in the right lower lobe.