Eosinophilic Pulmonary Syndromes of Known Etiology

Parasitic Infection

• General Comments
  • Parasite-Associated Eosinophilic Pneumonias Represent the Most Common Etiologies of Pulmonary Infiltrates with Eosinophilia Worldwide
• Capillaria Aerophila (see Capillariasis)
  • Epidemiology
    • Rare Etiology of Eosinophilic Pulmonary Infiltrates
• Clonorchis Sinensis (see Clonorchiasis)
  • Epidemiology
    • Rare Etiology of Eosinophilic Pulmonary Infiltrates
• Dirofilariasis (see Dirofilariasis)
  • Clinical
    • Eosinophilic Pulmonary Infiltrates
• Echinococcosis (see Echinococcosis)
• Paragonimiasis (see Paragonimiasis)
  • Epidemiology
    • Rare Etiology of Eosinophilic Pulmonary Infiltrates
• Schistosomiasis (see Schistosomiasis)
  • Manifestations of Schistosomiasis in the Lung Vary Dependent on the Stage of Disease
    • Early Acute Schistosomiasis: transient, multiple small pulmonary nodules with peripheral eosinophilia
    • Chronic Schistosomiasis: embolization of ova in small arteries of the lung results in granuloma formation, occlusion and remodeling of pulmonary arteries, and further pulmonary hypertension mediared by portopulmonary hypertension
    • Post-Treatment of Schistosomiasis: eosinophilic pneumonitis (lung shift, verminous pneumonia, reactionary Loffler-like pneumonitis) due to antigen release following treatment
• Simple Pulmonary Eosinophilia (Loffler Syndrome) (see Simple Pulmonary Eosinophilia)
  • Ascaris Lumbricoides (or Ascaris Suum): most common etiology of simple pulmonary eosinophilia (Loffler syndrome)
  • Necator Americanus
  • Ancylostoma Duodenale
  • Ancylostoma Brazliense or Canium
  • Entamoeba Histolytica
  • Fasciola Hepatica
  • Schistosomiasis (see Schistosomiasis)
    • Manifestations of Schistosomiasis in the Lung Vary Dependent on the Stage of Disease
      • Early Acute Schistosomiasis: transient, multiple small pulmonary nodules with peripheral eosinophilia
      • Chronic Schistosomiasis: embolization of ova in small arteries of the lung results in granuloma formation, occlusion and remodeling of pulmonary arteries, and further pulmonary hypertension mediared by portopulmonary hypertension
      • Post-Treatment of Schistosomiasis: eosinophilic pneumonitis (lung shift, verminous pneumonia, reactionary Loffler-like pneumonitis) due to antigen release following treatment
  • Strongyloides Stercoralis: simple pulmonary eosinophilia (Loffler syndrome) may occur when larvae migrate through the lungs after acute infection
• Strongyloides Stercoralis Hyperinfection Syndrome (see Strongyloides Stercoralis)
  • Epidemiology
    • Occurs in 20% of Patients Hospitalized with Strongyloidiasis and Coexisting Chronic Lung Disease (COPD, Asthma, etc)
  • Diagnosis
    • Rhabditiform Larvae May Be Recovered Via Bronchoalveolar Lavage, Bronchial Wash, or Sputum Sample
  • Clinical
    • Cough (see Cough)
    • Dyspnea (see Dyspnea)
    • Wheezing (see Wheezing)
    • Bilateral Patchy Infiltrates and Variable Degree of Eosinophilia
• Trichinosis (see Trichinosis)
  • Epidemiology
    • Rare Etiology of Eosinophilic Pulmonary Infiltrates
• Tropical Pulmonary Eosinophilia (Occult Filariasis) (see Tropical Pulmonary Eosinophilia)
  • Wuchereria Bancrofti
  • Brugia Malayi
  • Brugia Timori
• Visceral Larva Migrans (see Visceral Larva Migrans)
  • Toxocara Canis

Other Infection

• Aspergillus Niger (see Aspergillus)
  • Epidemiology
    • Case Reports of Eosinophilic Pneumonia
• Bipolaris Australiensis
  • Epidemiology
    • Case Reports of Eosinophilic Pneumonia
• Bipolaris Spicera
  • Epidemiology
    • Case Reports of Eosinophilic Pneumonia
• Brucellosis (see Brucellosis)
  • Epidemiology
    • Case Reports of Eosinophilic Pneumonia [Eosinophilia and pneumonitis in chronic brucellosis: a report of two cases. Ann Intern Med. 1942;16:995-1001]
• Coccidioidomycosis (see Coccidioidomycosis)
  • Clinical
    • Pronounced Peripheral Eosinophilia May Be an Early Indicator of Dissemination
• Cryptococcosis (see Cryptococcosis)
  • Epidemiology
    • Case Reports of Eosinophilic Pneumonia (South Med J, 1995) [MEDLINE]
• Histoplasmosis (see Histoplasmosis)
• Human Immunodeficiency Virus (HIV) (see Human Immunodeficiency Virus)
• Influenza Virus (see Influenza Virus)
  • Epidemiology
    • May Produce Eosinophilic Pneumonia in Some Cases
• Mycobacterium Simiae (see Mycobacterium Simiae)
  • Epidemiology
    • Case Reports of Eosinophilic Pneumonia (NEJM, 1989) [MEDLINE]
• Pneumocystis Jirovecii (PJP) (see Pneumocystis Jirovecii)
  • Epidemiology: BAL eosinophilia has been reported in HIV-associated cases
• Respiratory Syncytial Virus (RSV) (see Respiratory Syncytial Virus)
  • Epidemiology
    • May Produce Eosinophilic Pneumonia in Some Cases
• Tuberculosis (see Tuberculosis)
  • Epidemiology
    • May Produce Eosinophilic Pneumonia in Some Cases

Allergic Bronchopulmonary Aspergillosis and Related Syndromes

• Allergic Bronchopulmonary Aspergillosis (ABPA) (see Allergic Bronchopulmonary Aspergillosis)
• Allergic Bronchopulmonary Candidiasis (see Candida)
• Bronchocentric Granulomatosis (BCG) (see Bronchocentric Granulomatosis)

Drug-Induced Pulmonary Eosinophilia (see Drug-Induced Pulmonary Eosinophilia)

• More Than 80 Drugs/Toxins Have Been Reported to Cause Drug-Induced Pulmonary Eosinophilia

Other

• Breast Radiation-Associated Eosinophilic Pneumonia (see Radiation Therapy)
  • Clinical
    • Chronic Eosinophilic Pneumonia
• Eosinophilia-Myalgia Syndrome (see Eosinophilia-Myalgia Syndrome)
  • Physiology
    • Due to Contaminated L-Tryptophan (see L-Tryptophan)
• Toxic Rapeseed Oil Syndrome (see Contaminated Rapeseed Oil)
  • Physiology
    • Due to Contaminated Rapeseed Oil

Eosinophilic Pulmonary Syndromes of Unknown Etiology

• Eosinophilic Granulomatosis with Polyangiitis (EGPA, Churg-Strauss Syndrome) (see Eosinophilic Granulomatosis with Polyangiitis)
  • Clinical
    • Pneumonia-Like Presentation (with Fleeting Patchy Alveolar or Nodular Infiltrates) May Occur in 30% of Cases
• Hypereosinophilic Syndrome (see Hypereosinophilic Syndrome)
• Idiopathic Acute Eosinophilic Pneumonia (IAEP) (see Acute Eosinophilic Pneumonia)
• Idiopathic Chronic Eosinophilic Pneumonia (ICEP) (see Chronic Eosinophilic Pneumonia)
• Idiopathic Hypereosinophilic Obliterative Bronchiolitis (see Idiopathic Hypereosinophilic Obliterative Bronchiolitis)

Other Pulmonary Disorders with Possible Associated Pulmonary Eosinophilia

• Asthma (see Asthma)
• Eosinophilic Bronchitis (see Eosinophilic Bronchitis)
  • Clinical
    • Chronic Cough with Sputum Eosinophilia (About 40%)
    • Normal Lung Function with Absence of Bronchial Hyperreactivity: although it may evolve over time into either fixed airflow obstruction without asthma or into true asthma
    • Absence of Eosinophilic Pneumonia
• Gastric Cancer with Tumor-Related Production of GM-CSF and IL-5 (see Gastric Cancer)
  • Epidemiology
    • Case Report
• Hodgkin’s Disease (see Hodgkins Disease)
• Idiopathic Interstitial Pneumonias
  • Desquamative Interstitial Pneumonia (DIP) (see Desquamative Interstitial Pneumonia)
    • Mild BAL Eosinophilia May Occur in Some Cases
  • Non-Specific Interstitial Pneumonia (NSIP) (see Non-Specific Interstitial Pneumonia)
    • Mild BAL Eosinophilia May Occur in Some Cases
• Idiopathic Pulmonary Fibrosis (IPF) (see Idiopathic Pulmonary Fibrosis): mild BAL eosinophilia may occur in some cases
• Langerhans Cell Histiocytosis (LCH) (see Langerhans Cell Histiocytosis)
  • Diagnosis
    • Pulmonary Pathologic Lesions are Nodules (with Bronchiolocentric Stellate Shape) with Langerhans Cells and Variable Numbers of Eosinophils, Plasma Cells, and Lymphocytes
    • Eosinophils are Usually Present in the Initial, Active Stage of the Disease: they contribute to the eosinophilic granuloma
    • Eosinophils are Numerous in 25% of Cases: usually located at the periphery of the lesions
    • Eosinophils are Rare or Absent at the Chronic Stage of the Disease
• Lung Transplant (see Lung Transplant)
  • Acute Lung Transplant Rejection (Acute Cellular Lung Transplant Rejection) (see Acute Lung Transplant Rejection): peripheral eosinophilia may occur with/without pulmonary infiltrates (as acute rejection may be detected by surveillance bronchoscopy with transbronchial biopsy prior to the development of pulmonary infiltrates)
• Organizing Pneumonia (see Cryptogenic Organizing Pneumonia)
  • Diagnosis
    • Mild BAL Eosinophilia May Occur in Some Cases (Usually <20%)
• Sarcoidosis (see Sarcoidosis)
  • Diagnosis
    • Peripheral Eosinophilia (and Tissue Eosinophilia) May Be Present, But are Usually Mild