Loefflers syndrome differential diagnosis

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