Löeffler’s syndrome

Löeffler syndrome (LS) is a transient respiratory illness associated with peripheral eosinophilia (PE) and radiographic infiltrates (Meta-jevtovic et al., 2008Meta-jevtovic I. Tomovic M.S. Mojsilovic S. Petrovic M. Nonallergic simple eosinophilic pneumonia—Löffler syndrome—a case report study.Med Pregl. 2008; 61: 643-646Crossref PubMed Scopus (3) Google Scholar). Ascaris lumbricoides is the most common cause (Celandroni et al., 2002Celandroni A. Cinquanta L. Lagrasta U.E. Caprai S. Loeffler syndrome and Mycoplasma pneumonitis.Minerva Pediatr. 2002; 54: 243-247PubMed Google Scholar). We report a case of a 33-year-old man who presented with a four-day history of fever, dry cough and mild dyspnea in a Brazilian Amazon emergency department. Lung auscultation was normal. Chest radiograph showed bilateral pulmonary infiltrations (BPI) with mixed patterns (Figure 1A). High-resolution CT revealed bilateral scattered ground-glass opacities and peripheral consolidation (Figure 1B). Laboratory data showed 31,500 white blood cells per microliter with 65% of eosinophils. HIV serologic test, blood culture, parasitological stool microscopy using Hoffman, Pons and Janer, and Ritchie methods were negative. The patient was treated with antibiotics and prednisone. 48 h later, the patient presented improvement. After three months of follow-up, the patient had gastrointestinal symptoms and Hoffman, Pons and Janer, and Ritchie methods identify A. lumbricoides eggs. There was clinical improvement after treatment with mebendazole. LS is characterized by absence or presence of moderate symptoms and temporal BPI that may spontaneously improve (Celandroni et al., 2002Celandroni A. Cinquanta L. Lagrasta U.E. Caprai S. Loeffler syndrome and Mycoplasma pneumonitis.Minerva Pediatr. 2002; 54: 243-247PubMed Google Scholar). It should be considered a differential diagnosis in case of fever, asthma-like symptoms, BPI and living in endemic areas for parasitic infections, such Brazilian Amazon (Ekin et al., 2016Ekin S. Sertogullarindan B. Gunbatar H. Arisoy A. Yildiz H. Loeffler’s syndrome: an interesting case report.Clin Respir J. 2016; 10: 112-114Crossref PubMed Scopus (3) Google Scholar). Effective treatment may be achieved with corticosteroids (Akuthota and Weller, 2012Akuthota P. Weller P.F. Eosinophilic pneumonias.Clin Microbiol Rev. 2012; 25: 649-660Crossref PubMed Scopus (73) Google Scholar) and the appropriate use of anthelmintic drugs is indicated (Vijayan, 2008Vijayan V.K. Tropical parasitic lung diseases.Indian J Chest Dis Allied Sci. 2008; 50: 49-66PubMed Google Scholar). On behalf of all authors, the corresponding author states that there is no conflict of interest. There is no funding source.