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Oner Ozdemir
Division of Allergy and Immunology, Department of Pediatrics, Sakarya University Training Research and Hospital, Sakarya, Turkey
North Clin Istanb
doi: 10.14744/nci.2020.40121
Loefer’s syndrome: A type of eosinophilic pneumonia
mimicking community-acquired pneumonia and
asthma that arises from Ascaris lumbricoides in a child
Here, we describe a patient with Loeffler’s syndrome
initiated by Ascaris lumbricoides, who mimicked
the clinical picture of community-acquired pneumonia
(CAP) and bronchial asthma. A 5-year-old male child
was presented to an outside center with complaints of
cough, dyspnea, wheezing, intermittent fever for three
days. He was diagnosed with pneumonia after physical
and radiological evaluations then admitted for treatment
at an outside hospital. After discharge, his symptoms
decreased but persisted for several weeks and coughed
a substance up by sputum expectoration (Fig. 1). When
he presented to us, he seemed to be in a good general
condition, but his physical exam revealed coarse poly-
phonic rhonchi, especially on the upper zone of the left
lung. Evaluation of the peripheral blood smear of the pa-
tient demonstrated mounting eosinophilia (from 0.2% to
2.06%–338/mm3-), while IgE was 50 IU/mL. A chest
X-ray demonstrated unilateral upper zone patchy con-
solidation (pneumonic infiltrations) of the left lung (Fig.
2A). Despite antibiotic therapy, consolidation was not
resolved but almost completely vanished when he vom-
ited the parasite up (Fig. 2B). Macroscopic evaluation of
Original Images ALLERGY & IMMUNOLOGY
Cite this article as: Ozdemir O. Loefer’s syndrome: A type of eosinophilic pneumonia mimicking community-acquired pneumonia and
asthma that arises from Ascaris lumbricoides in a child. North Clin Istanb
UNCORRECTED PROOF
Received:
January 20, 2020
Accepted:
January 14, 2020
Online:
August 05, 2020
Correspondence: Oner OZDEMIR, MD. Sakarya Universitesi Egitim ve Arastirma Hastanesi, Cocuk Sagligi ve Hastaliklari
Anabilim Dali, Alerji ve Immunoloji Bilim Dali, Adapazari, Sakarya, Turkey.
Tel: +90 264 444 54 00 e-mail: ozdemir_oner@hotmail.com
© Copyright 2020 by Istanbul Provincial Directorate of Health - Available online at www.northclinist.com
Figure 1. The most common intestinal parasite (worm, As-
caris) in humans is seen after coughed up by the patient.
Figure 2. Pneumonia caused by the nematode Ascaris lum-
bricoides. Extraintestinal manifestations of ascariasis such
as pulmonary ascariasis, “Loefer’s syndrome”, are not com-
mon and can be misdiagnosed. Pneumonic inltration at the
upper lobe of the left lung (A) is shown. The appearance of
left lung (B) is seen after the patient coughed the worm up.
A B
North Clin Istanb
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the substance was confirmed as Ascaris lumbricoides by
microbiologists.
e patient was diagnosed with Loeffler’s syn-
drome, in which eosinophils gather in the pulmonary
tissue in regards to a parasitic infection. Loeffler’s syn-
drome should be thought early in the differential diag-
nosis for CAP and asthma, which is unresponsive to
classic antibiotic therapy in individuals if they live in
an endemic region for parasitic diseases in the devel-
oping countries [1, 2].
Informed Consent: Informed consent was obtained orally from
the patient’s father who participated in this report.
REFERENCES
1. Acar A, Oncül O, Cavuşlu S, Okutan O, Kartaloğlu Z. Case report:
Löffler’s syndrome due to Ascaris lumbricoides mimicking acute
bacterial community-acquired pneumonia. Turkiye Parazitol Derg
2009;33:239–41.
2. Deveci U, Üstün C, Altınsoy HB, Akay A, Özdiller S, Aydın M. Loef-
fler’s syndrome mimicking bronchial asthma and pneumonia in a child:
case report. Turkiye Parazitol Derg 2013;37:288–91.
