Loffler's syndrome (Pulmonary Eosinophilia)
Related Subjects: Asthma
|Acute Severe Asthma
|Eosinophilic granulomatosis (Churg Strauss)
|Loffler's syndrome (Pulmonary Eosinophilia)
|Pulmonary Eosinophilia and CXR changes
|Drug Reaction Eosinophilia Systemic Symptoms
📖 About
- 🌍 Löffler’s Syndrome, first described by Wilhelm Löffler in 1932, refers to transient pulmonary eosinophilia with fleeting radiographic infiltrates.
- Represents a hypersensitivity reaction to parasites, drugs, or allergens with eosinophilic infiltration of the lungs.
- Often self-limiting, but recognition is crucial to prevent repeated exposures or missed underlying causes.
🧬 Aetiology
- 💨 Allergic infiltration of alveoli by eosinophils in response to an exogenous trigger.
- Pathophysiology: eosinophil degranulation releases toxic proteins → airway inflammation, transient pulmonary infiltrates, bronchospasm.
🪱 Causes
- Parasitic (helminthic infections):
Ascaris lumbricoides 🪱, Strongyloides, Trichinella spiralis, Fasciola hepatica, Ankylostoma (hookworm), Toxocara, Clonorchis sinensis.
- Drug-induced:
Sulfonamides, hydralazine, nitrofurantoin, aspirin, penicillin 💊.
- Idiopathic eosinophilic lung disease (rare, autoimmune background).
🩺 Clinical Features
- Often asymptomatic — incidental finding on CXR.
- 🌡️ Low-grade fever, cough, mild wheeze, sometimes chest discomfort.
- Symptoms usually resolve spontaneously within 2–4 weeks once exposure ceases.
🔬 Investigations
- 🧪 Bloods: Eosinophilia (often >10%).
- 📸 Chest X-ray: Transient, patchy, migratory pulmonary infiltrates (usually resolve within 1–2 weeks).
- Optional: Sputum/stool microscopy for parasites; serology for parasitic infections if suspected.
💊 Management
- ✅ Identify and eradicate cause:
- Anthelmintics (e.g. albendazole, mebendazole) for helminths.
- Stop offending drugs immediately.
- 🌟 Supportive care: Often self-limiting; treat symptoms if present.
- 🧴 Steroids: Consider in idiopathic or severe cases with significant eosinophilic inflammation.
📌 Key Exam Pearls
- 🪱 Think of parasites in patients with travel history or eosinophilia + transient lung infiltrates.
- 💊 Always ask about drug history (nitrofurantoin & sulfonamides are high yield).
- 🎯 Compare with Churg–Strauss (EGPA) and chronic eosinophilic pneumonia for differentials.
📚 References
