Loefflers syndrome differential diagnosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Soroush Seifirad, M.D.[2]

Overview

Loeffler syndrome must be differentiated from other diseases that cause pulmonary eosinophilia, such as Churg-Strauss, drug and toxin-induced eosinophilic lung diseases, other helminthic and fungal infection related eosinophilic lung diseases, and nonhelminthic infections such as Coccidioidomycosis, and Mycobacterium tuberculosis.

Differentiating Loeffler syndrome from other pulmonary eosinophilia syndromes on the basis of etiology.

Diseases Clinical manifestations Para-clinical findings Gold standard Additional findings
Symptoms Physical examination
Lab Findings Imaging Histopathology
Symptom 1 Symptom 2 Symptom 3 Physical exam 1 Physical exam 2 Physical exam 3 Increased Eosinophil count

(High)

Increased Eosinophil count

(Mild to moderate)

Lab 3 Imaging 1 Imaging 2 Imaging 3
Helminthic

and fungal infection-related

eosinophilic lung diseases

Transpulmonary

passage of larvae (Loffler's syndrome)

  • Ascaris lumbricoides
  • Hookworms such as:
  • Ancylostoma duodenale
  • Necator americanus)
  • Strongyloides stercoralis
Tropical

pulmonary

eosinophilia

40 to 70 percent
  • Wuchereria bancrofti
  • Brugia malayi
Allergic bronchopulmonary aspergillosis *
Heavy

hematogenous

seeding

with

helminths

  • Trichinellosis
  • Disseminated strongyloidiasis
  • Cutaneous and visceral larva migrans
  • Schistosomiasis
Pulmonary parenchymal invasion
  • Helminths such as paragonimiasis
Nonhelminthic infections Coccidioidomycosis
Mycobacterium tuberculosis
Eosinophilic granulomatosis with polyangiitis (Churg-Strauss) *
Drug- and toxin-induced eosinophilic lung diseases *
  • Nonsteroidal antiinflammatory drugs
  • Phenytoin
  • L-tryptophan
  • Antibiotics (nitrofurantoin, minocycline, sulfonamides, ampicillin, daptomycin)
Acute eosinophilic pneumonia
Chronic eosinophilic pneumonia ≥40 percent
Idiopathic acute eosinophilic pneumonia ≥25 percent
Diseases Symptom 1 Symptom 2 Symptom 3 Physical exam 1 Physical exam 2 Physical exam 3 Increased Eosinophil count

(High)

Increased Eosinophil count

(Mild to moderate)

Lab 3 Imaging 1 Imaging 2 Imaging 3 Histopathology Gold standard Additional findings
Sarcoidosis *
Pulmonary Langerhans cell histiocytosis (Histiocytosis X) *
Idiopathic pulmonary fibrosis <10 percent
Differential Diagnosis 7

References

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