Tropical Pulmonary Eosinophilia

Migrating

Step 1: View clinicals

A 27 year old man presents with a non-productive, paroxysmal, nocturnal cough for five days associated with breathlessness and wheezing. There is no history of chronic respiratory illness, atopy or tuberculosis. His medical, surgical, and drug histories are unremarkable. He does not smoke or consume alcohol. He migrated from India to the United States just 4 months ago. Initial investigations reveal a white cell count of 28,000/mm3, with an eosinophilia of 21,300/mm3. A chest x-ray reveals scattered reticulonodular infiltrates in the mid and lower zones of both lungs.


Step 2: Order all relevant investigations

Stool Microscopy

No ova or parasites seen.

Serum IgE levels

IgE: 24,020 kU/L (0-120)

Filaria specific IgG levels

Filaria specific IgG: Positive

Serology for Toxocariasis

Serology for toxocariasis: Negative


Step 3: Select appropriate management

Supplemental Oxygen
Diethylcarbamazine
Prednisolone
Ivermectin


Score: ★★☆