Loffler's syndrome associated with Clonorchis sinensis infestation

Abstract

In 1932, Loffler described a syndrome of self-limiting, transient pulmonary infiltrates associated with peripheral blood eosinophilia and mild pulmonary symptoms. A number of conditions are related to pulmonary eosinophilia or pulmonary infiltration with eosinophilia. Especially, parasitic infestations are often related to pulmonary eosinophilia, but only two cases associated with Clonorchis sinensis have been anecdotally reported in English literature. Here we report a case of migrating pulmonary eosniophilic infiltrations associated with Clonorchis sinensis that was successfully treated with praziquantel. Clonorchiasis should be considered in patients with marked eosinophilia and pulmonary infiltrations.

Figure 1.

Initial chest radiograph shows a solitary pulmonary nodule in the right upper lung (arrow).

Figure 2.

Serial chest radiographs, at second hospital day (A), 4th day (B) show nodular and patchy densities that migrate to different sites and change in size and shape (arrows).

Figure 3.

Outside chest CT scan (A) and follow-up chest CT scan (B, C) show migrating pulmonary nodules.

Figure 4.

Intensely eosinophilic granular cytoplasm (BAL, Wright-Giemsa, ×1000).

Figure 5.

Transbronchial lung biopsy specimen shows numerous eosinophils infiltrating the interstitium and alveolar space (A: H&E, ×100, B: ×400).

Figure 6.

Chest radiograph shows resolution of nodular densities after oral praziquantel therapy.