Definition

What is Löffler syndrome?

Initially described by Löffler in 1932, Löffler syndrome (a form of eosinophilic pulmonary disease) is a medical condition characterized by absent or mild respiratory symptoms (most often dry cough), fleeting migratory pulmonary opacities, and peripheral blood eosinophilia.

How common is Löffler syndrome?

Please discuss with your doctor for further information.

Symptoms

What are the symptoms of Löffler syndrome?

Symptoms of Löffler syndrome are usually mild or absent and tend to spontaneously resolve after several days or, at most, after 2-3 weeks. Cough is the most common symptom among symptomatic patients. It is usually dry and unproductive but may be associated with production of small amounts of mucoid sputum.

Parasitic infection

Symptoms appear 10-16 days after ingestion of Ascaris eggs. A similar timeframe has been described for Löffler syndrome associated with N americanus, A duodenale, or S stercoralis infection.

Fever, malaise, cough, wheezing, and dyspnea are the most common symptoms. Less commonly, the patient may present with myalgia, anorexia, and urticaria.

Social and travel history should be carefully elicited to identify risk factors for exposure to parasites.

Drug-induced pulmonary eosinophilia

Symptoms may start hours after taking the medications or, more commonly, after several days of therapy.

Dry cough, breathlessness, and fever are common.

Obtain a detailed drug history, including prescription and over-the-counter medications, nutritional supplements, and illicit drugs.

There may be some symptoms not listed above. If you have any concerns about a symptom, please consult your doctor.

When should I see my doctor?

If you or your loved one has any signs or symptoms listed above or you have any questions, please consult with your doctor. Everyone’s body acts differently. It is always best to discuss with your doctor what is best for your situation.

Causes

What causes Löffler syndrome?

Most cases of simple pulmonary eosinophilia are caused by parasitic infections (especially Ascaris lumbricoides) or drugs; however, no cause is identified in one third of patients.

Parasites

  • Ascaris lumbricoides (the most common parasitic etiology)
  • Ascaris suum
  • Necator americanus
  • Strongyloides stercoralis
  • Ancylostoma braziliense
  • Ancylostoma caninum
  • Ancylostoma duodenale
  • Toxocara canis
  • Toxocara cati
  • Entamoeba histolytica
  • Fasciola hepatica
  • Dirofilaria immitis
  • Clonorchis sinensis
  • Paragonimus westermani

Agents in drug-induced eosinophilia

Antimicrobials – Dapsone, ethambutol, isoniazid, nitrofurantoin, penicillins, tetracyclines, clarithromycin, pyrimethamine, daptomycin.

Anticonvulsants – Carbamazepines, phenytoin, valproic acid, ethambutol.

Anti-inflammatories and immunomodulators – Aspirin, azathioprine, beclomethasone, cromolyn, gold, methotrexate, naproxen, diclofenac, fenbufen, ibuprofen, phenylbutazone, piroxicam, tolfenamic acid.

Other agents – Bleomycin, captopril, chlorpromazine, granulocyte-macrophage colony-stimulating factor, imipramine, methylphenidate, sulfasalazine, sulfonamides.

Risk factors

What increases my risk for Löffler syndrome?

Intestinal helminthiases associated with Löffler syndrome are distributed worldwide; however, they are more prevalent in tropical climates, especially in communities with poor sanitary conditions.

Because young children are exposed to contaminated soil and exhibit hand-to-mouth behavior more often than adults, they have a higher incidence of intestinal helminthiases and Löffler syndrome.

Please consult with your doctor for further information.

Diagnosis & treatment

The information provided is not a substitute for any medical advice. ALWAYS consult with your doctor for more information.

How is Löffler syndrome diagnosed?

Laboratory Studies

The following studies are indicated in Löffler syndrome:

  • CBC count with differential
  • Results show mild blood eosinophilia, usually 5-20%.
  • Eosinophils may account for as much as 40% of the WBC differential in patients with drug-induced eosinophilia.
  • Stool examinationParasites and ova can be found in the stool 6-12 weeks after the initial parasitic infection.
  • Pulmonary symptoms usually resolve by the time parasitic forms are found in the stool.
  • Immunoglobulin E (IgE) level: This may be elevated.
  • Analysis of sputum or gastric lavages: Larvae are occasionally found in sputum and gastric aspirates at the time of pulmonary symptoms.
  • Bronchoalveolar lavage: The eosinophilic count may be elevated.

Imaging Studies

  • Chest radiography
  • Chest CT scanning
  • Bronchoscopy and bronchoalveolar lavage

Histologic Findings

  • Pathologic changes in the lungs have been described in patients who died from another cause while they concomitantly had simple pulmonary eosinophilia.
  • Eosinophilic infiltration occurs in the bronchi and bronchioles and in the alveolar and interstitial spaces. Parasitic forms are usually not found in the lungs.

How is Löffler syndrome treated?

The minimal nature of symptoms in most patients with Löffler syndrome usually denotes that no pharmacologic therapy is required for this self-limiting condition. For drug-induced pulmonary eosinophilia, discontinue administration of the offending drug. When a parasitic infection is documented, appropriate use of anthelmintic drugs is indicated. In severe cases of simple pulmonary or drug-induced eosinophilia, systemic corticosteroids are highly effective.

Surgical care is not indicated.

Lifestyle changes & home remedies

What are some lifestyle changes or home remedies that can help me manage Löffler syndrome?

Repeat chest radiography 4-6 weeks after initial presentation to document resolution of pulmonary infiltrates in patients with Löffler syndrome.

Repeat CBC count 4-6 weeks after initial presentation to document resolution of eosinophilia.

Examine stool for ova and parasites 6-12 weeks after initial presentation.

If you have any questions, please consult with your doctor to better understand the best solution for you.

Hello Health Group does not provide medical advice, diagnosis or treatment.

Review Date: April 7, 2018 | Last Modified: April 7, 2018

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