A Rare Case of Tropical Pulmonary Eosinophilia in a 9-Year Old Male Child

Tropical Pulmonary Eosinophilia (TPE) is one of a number of syndromes characterized by pulmonary infiltrates and peripheral eosinophilia. TPE is a variant of filariasis that results from a hypersensitivity response to the microfilariae of the lymphatic-dwelling parasites, Wuchereria bancrofti and Brugia malayi. The differential diagnosis of eosinophilic lung disease includes Loeffler syndrome secondary to helminth infection or drug reaction; allergic bronchopulmonary aspergillosis; chronic eosinophilic pneumonia; vasculitis, such as Churg-Strauss syndrome, polyarteritis nodosa, and Wegener granulomatosis; and idiopathic hypereosinophilic syndrome. TPE is a very rare presentation in the pediatric age group.

We present a case of a 9-year old male child with low grade intermittent night fever & vomiting with a non-productive cough for the last 1 month. He had hepatosplenomegaly, but cardiovascular and respiratory system was normal.

On investigation, it was found to have 58% eosinophilia (AEC > 20000). The HRCT revealed mosaic attenuation of B/L upper lobe, fibroelastic band in right lung anterior & middle lobe superior segment. Tuberculosis was excluded by negative CBNAAT. Patient was treated with Albendazole and Wysolone considering it as a case of Hypereosinophilic syndrome. But no significant improvement was noticed in the next five days. In the meantime, we sent a microfilaria antigen test which came positive. Then we revised our diagnosis to a case of Tropical Pulmonary Eosinophilia and started with DEC. Now the patient showed marked improvement in three days and got discharged in asymptomatic condition.

Individuals with TPE often receive an incorrect diagnosis of asthma, despite their poor response to standard treatments for asthma. Early recognition and treatment of TPE with diethylcarbamazine is key to minimizing morbidity and mortality, because chronic untreated TPE may lead to progressive, irreversible pulmonary fibrosis.

Parents were very happy to get their child diagnosed and treated properly in KIMS. They showered their blessing to staff and doctors taking care of their kid. We are thankful to the management for providing infrastructure and diagnostic facilities to carry-out our work.

This case was managed by a KIMS paediatric team consisting of Prof. S. R. Biswal, Prof. Nirmal K. Mohakud, Dr. Arun K Dash and Post graduates (Dr Nikitha, Dr Jishnu, Dr Puramjay).