Loffler Syndrome Clinical Presentation
- Author: Girish D Sharma, MD, FCCP, FAAP; Chief Editor: Michael R Bye, MD more...
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.
See the list below:
- Usually, no abnormalities are found on physical examination. Cutaneous features of hypereosinophilic syndrome are described in a recent review article.
- Occasionally, crackles or wheezes may be heard on lung auscultation. Patients with drug-induced pulmonary eosinophilia commonly have crackles on physical examination.
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.
- 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
- 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
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