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.
A Turkish case report describes a 5-year-old boy with Löffler syndrome caused by A lumbricoides, who initially presented with a 3-day history of cough, dyspnea, wheezing, and intermittent fever. [4]
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. [5, 6]
Obtain a detailed drug history, including prescription and over-the-counter medications, nutritional supplements, and illicit drugs.
Physical Examination
Usually, no abnormalities are found on physical examination. Cutaneous features of hypereosinophilic syndrome are described in a review article. [7]
Occasionally, crackles or wheezes may be heard on lung auscultation. Patients with drug-induced pulmonary eosinophilia commonly have crackles on physical examination.
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Initial chest radiograph of a 54-year-old man showing subtle opacity (arrows) in the right middle lung zone.
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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.
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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.
