Pulmonary Infiltrates with Eosinophilia PIE



The combination of pulmonary infiltrates and peripheral eosinophilia occurs in five relatively well-characterized disorders. Loffler’s syndrome is a benign condition characterized by fleeting pulmonary infiltrates and eosinophilia, probably related to an immune response to some external agent. It is often asymptomatic, but fever and cough may occur. Although recurrent, it usually clears within 4 to 6 weeks, and it also displays a rapid response to steroids. Chronic eosinophilic pneumonia is a more symptomatic form of PIE, often persistent or recurrent in nature. Because of its tendency to involve the periphery of the lung, its roentgenographic appearance is called the in­verse of pulmonary edema. Despite a rapid re­sponse to corticosteroids, relapse may occur once treatment is discontinued, so that therapy may be required for a year or more. PIE in asthma is most commonly due to allergic bronchopulmonary as­pergillosis, which may result in a central destruc­tive bronchiectasis. Tropical eosinophilia consists of symptoms of wheeze, fever, and a diffuse reticulonodular pattern on the x-ray that is thought to result from an infestation with micro­filaria of Wuchereria bancrofti. Finally, it may be associated with a collagen-vascular disease, in which case the underlying disorder determines the overall presentation.