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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