Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

Loffler Syndrome Clinical Presentation

  • Author: Girish D Sharma, MD, FCCP, FAAP; Chief Editor: Michael R Bye, MD  more...
 
Updated: Mar 05, 2014
 

History

Symptoms of Löffler syndrome are usually mild or absent and tend to spontaneously resolve after several days or, at most, after 2-3 weeks. Cough is the most common symptom among symptomatic patients. It is usually dry and unproductive but may be associated with production of small amounts of mucoid sputum.

  • Parasitic infection
    • Symptoms appear 10-16 days after ingestion of Ascaris eggs. A similar timeframe has been described for Löffler syndrome associated with N americanus, A duodenale, or S stercoralis infection.
    • Fever, malaise, cough, wheezing, and dyspnea are the most common symptoms. Less commonly, the patient may present with myalgia, anorexia, and urticaria.
    • Social and travel history should be carefully elicited to identify risk factors for exposure to parasites.
  • Drug-induced pulmonary eosinophilia
    • Symptoms may start hours after taking the medications or, more commonly, after several days of therapy.
    • Dry cough, breathlessness, and fever are common.
    • Obtain a detailed drug history, including prescription and over-the-counter medications, nutritional supplements, and illicit drugs.
Next

Physical

See the list below:

  • Usually, no abnormalities are found on physical examination. Cutaneous features of hypereosinophilic syndrome are described in a recent review article.[2]
  • Occasionally, crackles or wheezes may be heard on lung auscultation. Patients with drug-induced pulmonary eosinophilia commonly have crackles on physical examination.
Previous
Next

Causes

See the list below:

  • Most cases of simple pulmonary eosinophilia are caused by parasitic infections or drugs; however, no cause is identified in one third of patients.
  • Parasites
    • Ascaris lumbricoides (the most common parasitic etiology)
    • Ascaris suum
    • Necator americanus
    • Strongyloides stercoralis
    • Ancylostoma braziliense
    • Ancylostoma caninum
    • Ancylostoma duodenale
    • Toxocara canis
    • Toxocara cati
    • Entamoeba histolytica
    • Fasciola hepatica
    • Dirofilaria immitis
    • Clonorchis sinensis
    • Paragonimus westermani
  • Agents in drug-induced eosinophilia
    • Antimicrobials - Dapsone, ethambutol, isoniazid, nitrofurantoin, penicillins, tetracyclines, clarithromycin, pyrimethamine, daptomycin[3]
    • Anticonvulsants - Carbamazepines, phenytoin, valproic acid, ethambutol
    • Anti-inflammatories and immunomodulators - Aspirin, azathioprine, beclomethasone, cromolyn, gold, methotrexate, naproxen, diclofenac, fenbufen, ibuprofen, phenylbutazone, piroxicam, tolfenamic acid
    • Other agents - Bleomycin, captopril, chlorpromazine, granulocyte-macrophage colony-stimulating factor, imipramine, methylphenidate, sulfasalazine, sulfonamides
Previous
 
 
Contributor Information and Disclosures
Author

Girish D Sharma, MD, FCCP, FAAP Professor of Pediatrics, Rush Medical College; Director, Section of Pediatric Pulmonology and Rush Cystic Fibrosis Center, Rush Children's Hospital, Rush University Medical Center

Girish D Sharma, MD, FCCP, FAAP is a member of the following medical societies: American Academy of Pediatrics, American College of Chest Physicians, American Thoracic Society, Royal College of Physicians of Ireland

Disclosure: Nothing to disclose.

Coauthor(s)

Michael J Vinikoor, MD Fellow in Infectious Diseases, Department of Internal Medicine, University of North Carolina at Chapel Hill School of Medicine

Michael J Vinikoor, MD is a member of the following medical societies: American Academy of Pediatrics

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Charles Callahan, DO Professor, Chief, Department of Pediatrics and Pediatric Pulmonology, Tripler Army Medical Center

Charles Callahan, DO is a member of the following medical societies: American Academy of Pediatrics, American College of Chest Physicians, American College of Osteopathic Pediatricians, American Thoracic Society, Association of Military Surgeons of the US, Christian Medical and Dental Associations

Disclosure: Nothing to disclose.

Chief Editor

Michael R Bye, MD Professor of Clinical Pediatrics, State University of New York at Buffalo School of Medicine; Attending Physician, Pediatric Pulmonary Division, Women's and Children's Hospital of Buffalo

Michael R Bye, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Chest Physicians, American Thoracic Society

Disclosure: Nothing to disclose.

Additional Contributors

Girish D Sharma, MD, FCCP, FAAP Professor of Pediatrics, Rush Medical College; Director, Section of Pediatric Pulmonology and Rush Cystic Fibrosis Center, Rush Children's Hospital, Rush University Medical Center

Girish D Sharma, MD, FCCP, FAAP is a member of the following medical societies: American Academy of Pediatrics, American College of Chest Physicians, American Thoracic Society, Royal College of Physicians of Ireland

Disclosure: Nothing to disclose.

References
  1. Kunst H, Mack D, Kon OM, et. al. Parasitic infections of the lung: a guide for the respiratory physician. Thorax. 2011. 66:528-36.

  2. Plotz SG, Huttig B, Aigner B. et al. Clinical overview of cutaneous features in hypereosinophilic syndrome. Current Allergy Asthma Report. 2012. 12:85-98.

  3. Shinde A, Seifi A, DelRe S, et al. Daptomycin-induced pulmonary infiltrates with eosinophilia. J Infect. Feb 2009. 58(2):173-4. [Medline].

  4. Janz DR, O'Neal HR Jr, Ely EW. Acute eosinophilic pneumonia: A case report and review of the literature. Crit Care Med. 2009 Apr. 37(4):1470-4. [Medline].

  5. [Guideline] Institute for Clinical Systems Improvement (ICSI). Diagnosis and treatment of respiratory illness in children and adults. 2008 Jan. [Full Text].

  6. Sen T, Ponde CK, Udwadia ZF. Hypereosinophilic syndrome with isolated Loeffler's endocarditis: complete resolution with corticosteroids. J Postgrad Med. 2008 Apr-Jun. 54(2):135-7. [Medline].

  7. Abdul-Hadi S, Diaz-Bello Z, Zavala-Jaspe R, et al. Pulmonary paragonimiasis. Case report. Invest Clin. Jun 2008. 49(2):257-64. [Medline].

  8. Alberts WM. Eosinophilic interstitial lung disease. Curr Opin Pulm Med. 2004 Sep. 10(5):419-24. [Medline].

  9. Allen JN, Davis WB. Eosinophilic lung diseases. Am J Respir Crit Care Med. 1994 Nov. 150(5 Pt 1):1423-38. [Medline].

  10. Carroll JL, Sterni LM. Eosinophilic lung disorders and hypersensitivity pneumonitis. Taussig LM, Landau LI, eds. Pediatric Respiratory Medicine. St Louis, Mo: Mosby; 1999. 804-10.

  11. Corrin B. The lungs. Systemic Pathology. 3rd ed. London, England: Churchill Livinstone; 1990. 191.

  12. Cottin V, Cordier JF. Eosinophilic pneumonias. Allergy. 2005 Jul. 60(7):841-57. [Medline].

  13. Crofton JW, Livingstone JL, Oswald NC, Roberts AT. Pulmonary eosinophilia. Thorax. 1952 Mar. 7(1):1-35. [Medline].

  14. Das AM, Williams TJ, Lobb R, Nourshargh S. Lung eosinophilia is dependent on IL-5 and the adhesion molecules CD18 and VLA-4, in a guinea-pig model. Immunology. 1995 Jan. 84(1):41-6. [Medline].

  15. Fujimura M, Yasui M, Shinagawa S, et al. Bronchoalveolar lavage cell findings in three types of eosinophilic pneumonia: acute, chronic and drug-induced eosinophilic pneumonia. Respir Med. 1998 May. 92(5):743-9. [Medline].

  16. Katz U, Shoenfeld Y. Pulmonary eosinophilia. Clin Rev Allergy Immunol. Jun 2008. 34(3):367-71. [Medline].

  17. Kaufman J, O'Shaughnessy IM. Eosinophilic pleural effusion associated with valproic acid administration. South Med J. 1995 Aug. 88(8):881-2. [Medline].

  18. Kim Y, Lee KS, Choi DC, et al. The spectrum of eosinophilic lung disease: radiologic findings. J Comput Assist Tomogr. 1997 Nov-Dec. 21(6):920-30. [Medline].

  19. Lee HK, Jin SL, Lee HP, et al. Loffler's syndrome associated with Clonorchis sinensis infestation. Korean J Intern Med. 2003 Dec. 18(4):255-9. [Medline].

  20. Ler WZ. Differential-diagnose der lungen infiltrierungen: er fle succedan-infiltrate (mit eosinophilia). Beitr Klin Tuberk. 1932. 79:368-92.

  21. Nadeem S, Nasir N, Israel RH. Loffler's syndrome secondary to crack cocaine. Chest. 1994 May. 105(5):1599-600. [Medline].

  22. Neva FA, Brown HW. Intestinal nematodes. Basic Clinical Parasitology. 6th ed. Norwalk, Conn: Appleton & Lange; 1994. 113-51.

  23. Nogami M, Suko M, Okudaira H, et al. Experimental pulmonary eosinophilia in mice by Ascaris suum extract. Am Rev Respir Dis. 1990 May. 141(5 Pt 1):1289-95. [Medline].

  24. O'Sullivan BP, Nimkin K, Gang DL. A fifteen-year-old boy with eosinophilia and pulmonary infiltrates. J Pediatr. 1993 Oct. 123(4):660-6. [Medline].

  25. Ohnishi H, Abe M, Yokoyama A, et al. Clarithromycin-induced eosinophilic pneumonia. Intern Med. 2004 Mar. 43(3):231-5. [Medline].

  26. Pawlowski ZS. Ascariasis. Warren KS, Mahmoud AAF, eds. Tropical and Geographical Medicine. 2nd ed. New York, NY: McGraw-Hill; 1990. 369.

  27. Sharma OP, Bethlem EP. The pulmonary infiltration with eosinophilia syndrome. Curr Opin Pulm Med. 1996 Sep. 2(5):380-9. [Medline].

  28. Takafuji S, Nakagawa T. Drug-induced pulmonary disorders. Intern Med. 2004 Mar. 43(3):169-70. [Medline].

  29. Wang J, Palmer K, Lotvall J, et al. Circulating, but not local lung, IL-5 is required for the development of antigen-induced airways eosinophilia. J Clin Invest. 1998 Sep 15. 102(6):1132-41. [Medline]. [Full Text].

  30. Wong-Waldamez A, Silva-Lizama E. Bullous larva migrans accompanied by Loeffler's syndrome. Int J Dermatol. 1995 Aug. 34(8):570-1. [Medline].

Previous
Next
 
Initial chest radiograph of a 54-year-old man showing subtle opacity (arrows) in the right middle lung zone.
Follow-up chest radiograph of a 54-year-old man showing migrating opacity in the left lower lobe (arrows) obtained 20 days after the previous image.
High-resolution CT scan (1 mm collimation) obtained in a 54-year-old man showing consolidation with surrounding ground-glass opacity in the left lower lobe. Dilated airways are observed within the lesion. This CT scan was obtained between the first and second images above.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.