Loffler Syndrome Clinical Presentation

Updated: Feb 13, 2017
  • Author: Girish D Sharma, MD, FCCP, FAAP; Chief Editor: Denise Serebrisky, MD  more...
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Presentation

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 [2, 3]

    • 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.

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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. [4]

  • 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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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 [5]

    • 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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