Tropical Pulmonary Eosinophilia : Masquerading as Eosinophilic Leukaemia.

Benign conditions like Tropical Pulmonary Eosinophilia(TPE) can present with very high total count and Absolute Eosinophil Count (AEC) and can mimick malignancy. Diagnostic work up for TPE should be done in any patient presenting with pulmonary symptoms and eosinophilia. Though most case series on TPE report AEC in range of 3000 to upto 20,000, very rarely AEC can rise beyond 50,000. The following case is of TPE presenting with absolute eosinophil count of >70,000. Rapid response to Diethyl carbamazine is the rule in a confirmed case of TPE.

Eosinophilic pneumonia: experience at two tertiary care referral hospitals in Saudi Arabia

Eosinophilic lung diseases are a diverse group of disorders characterized by pulmonary opacities associated with tissue or peripheral eosinophilia. A retrospective study conducted at two tertiary care hospitals from January 1999 to December 2009. All cases with the diagnosis of pulmonary eosinophilia were reviewed over a period of 10 years. Data on demographic, clinical, and radiologic characteristics were collected. Thirty-five patients with a mean age of 33.9 [16.2] years, of which 20 [57.1%] were male and meeting the criteria of eosinophilic lung disease were identified. Cough and dyspnea were the most frequent symptoms at presentation in 29 [82.9%] and 27 [77.1%] patients, respectively. Reticulonodular and airspace patterns were the most common radiographic findings in 17 [48.6%] and 15 [42.9%] patients, respectively. Peripheral eosinophilia was present in 33 [94.3%] patients. Twenty-four patients [68.6%] were labeled as having idiopathic pulmonary infiltrate with eosinophilia. Complete remission was achieved in 13 [54.2%] of 24 patients, while 10 [41.7%] patients relapsed within a few months of discontinuation of therapy. Specific therapy for a specific disease was administered in 8 patients: 2 patients for pulmonary tuberculosis, 2 for Churg-Strauss syndrome, 1 for lymphoma, 1 for schistosomiasis, 1 for acute eosinophilic pneumonia, and 1 for Wegener granuloma; 3 patients were treated as allergic bronchopulmonary aspergillosis. Pulmonary eosinophilia remains rare but challenging, and it can have the same diverse clinical and radiographic presentations seen with other common pulmonary conditions. Clinicians should be alert to these syndromes and must think of them in any lung disease differential diagnoses

Tropical pulmonary eosinophilia and filariasis in Pakistan.

Filariasis is a major health problem in South Asia, particularly India, Sri Lanka and Bangladesh. Pakistan was presumed to be not affected. We report for the first time confirmed cases of tropical pulmonary eosinophilia (TPE) in indigenous patients as a result of infection with Wuchereria bancrofti. Following clinical examination, total leukocyte and eosinophil counts were recorded. Parasitological examinations included blood for microfilariae and stool and urine for eggs of intestinal parasites. Total immunoglobulin (Ig) E and specific antifilarial IgG were measured. Suspected cases of TPE were treated with diethylcarbamazine, 6 mg/kg for four weeks and were followed up to 2 and 4 weeks after treatment. Four persons fulfilled the criteria for TPE. Their response to treatment was marked with clinical improvement, reduction in eosinophil count and reduced titers of specific antifilarial antibodies. Two persons had W. bancrofti antigen in their sera confirmed by filariasis antigen detection test. Tropical pulmonary eosinophilia due to Wuchereria. bancrofti, although rare, is present in Pakistan.

Angeitis alérgica granulomatosa

Presentamos el caso de una mujer de 38 años con asma, eosinofilia periférica, sinusitis y opacidades interticiales difusas, bilaterales y fugaces en la radiografía de tórax. El procedimiento diagnóstico fue biopsia pulmonar a cielo abierto donde se encontró una vasculitis eosinofilica características del Síndrome de Churg-Strauss. Comentamos los principales hallazgos clínicos, radiológicos e histopatológicos.

Tropical pulmonary eosinophilia in an Orissa village.

BACKGROUND. Tropical pulmonary eosinophilia is usually seen in areas endemic for filariasis. It affects only a small proportion of the population at risk and microfilaria are rarely demonstrated in the peripheral blood. The actual prevalence of the tropical pulmonary eosinophilia syndrome has not been previously studied in an area endemic for filariasis. METHODS. We screened the population of a village in the Puri district of Orissa, where filarial infection is endemic, to determine the prevalence of tropical pulmonary eosinophilia by clinical examination measuring the absolute eosinophil counts, performing a chest X-ray and examining the stools for the presence of the parasite. Sera from symptomatic cases who had an eosinophil count above 2000 per cmm were further tested for filarial specific IgG and total IgE and the results compared with control sera obtained from 15 age- and sex-matched normal individuals. RESULTS. We were able to screen 1754 (91%) out of 1918 villagers who were more than 5 years old and found 69 cases who had typical clinical features of tropical pulmonary eosinophilia. Only 6 (0.34%) of these had eosinophil counts above 3000 per cmm and were considered to have the disease. Only 2 of the 6 had associated filarial lesions, one had microfilaraemia and 3 had typical chest X-ray changes. The mean (+/- SD) titres for filaria specific IgG (0.355 +/- 0.315 v. 0.120 +/- 0.092) and total IgE (0.455 +/- 0.316 v. 0.114 +/- 0.075) were significantly higher in cases with tropical pulmonary eosinophilia than in control subjects. The level of eosinophilia was related neither to the patients' immune status nor to the severity of the radiological lesions. All cases recovered after therapy with diethylcarbamazine. CONCLUSION. Tropical pulmonary eosinophilia is not uncommon in this community in Orissa where filariasis is endemic. However, the syndrome is rarely associated with clinical filarial lesions.