Tropical pulmonary eosinophilia-mimicking acute severe asthma: a case report

Tropical pulmonary eosinophilia (TPE) is a rare but serious infection characterized by wheezing, fever, and eosinophilia, with clinical features such as paroxysmal cough, wheezing, and dyspnoea. TPE is diagnosed by a history of filarial endemic regions and peripheral eosinophilia >3,000/mm3. It can be easily missed but can be a differential for bronchial asthma and tuberculosis. A 15-year-old male with cough and breathlessness for three years was diagnosed with TPE after laboratory investigations showed leucocytosis with eosinophilia. A provisional diagnosis was considered, and diethylcarbamazine (DEC) was started at a dose of 6 mg/kg body weight for 21 days, with improvement in the patient's symptoms. TPE affects 51.4 million people globally and is often misdiagnosed as other conditions like bronchial asthma, military tuberculosis, and interstitial lung disease. The diagnostic criteria for TPE include a history of residence or travel to a filarial endemic region, paroxysmal and nocturnal cough with dyspnoea, leucocytosis with peripheral blood eosinophilia>3000/mm3, elevated serum IgE and filarial antibody titres, pulmonary infiltrations in chest X-ray, and clinical improvement with DEC.