Löffler syndrome on a Louisiana pig farm

Kevin Gipson; Ryan Avery; Heena Shah; Derek Pepiak; Rodolfo E Bégué; John Malone; Luke A Wall

doi:10.1016/j.rmcr.2016.09.003

Löffler syndrome on a Louisiana pig farm

Respir Med Case Rep. 2016 Sep 16:19:128-131. doi: 10.1016/j.rmcr.2016.09.003. eCollection 2016.

Authors

Kevin Gipson¹, Ryan Avery², Heena Shah³, Derek Pepiak⁴, Rodolfo E Bégué⁵, John Malone², Luke A Wall³

Affiliations

¹ Division of Pediatric Pulmonology, Department of Pediatrics, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
² Louisiana State University School of Veterinary Medicine, Department of Pathobiological Sciences, Baton Rouge, LA, USA.
³ Section of Allergy Immunology, Department of Pediatrics, Louisiana State University Health Sciences Center and Children's Hospital New Orleans, New Orleans, LA, USA.
⁴ Division of Pediatric Pulmonology, Department of Pediatrics, Ochsner for Children and the University of Queensland School of Medicine, New Orleans, LA, USA.
⁵ Section of Infectious Diseases, Department of Pediatrics, Louisiana State University Health Sciences Center and Children's Hospital New Orleans, New Orleans, LA, USA.

Abstract

Löffler syndrome, a fulminant eosinophilic pneumonitis associated with the larval migratory phase of human parasites, is rarely reported in the United States. A previously healthy 8-year-old male was hospitalized with tachypnea, cough, hypoxemia, and fever of one week's duration. History revealed exposure to pigs on his family's farm in southernmost Louisiana, where the patient was responsible for cleaning the farm's pigpens. His fingernails were soiled and extremely short, with the edge of the nail bed exposed secondary to onychophagia. Laboratory evaluation demonstrated peripheral eosinophilia (39%), pulmonary eosinophilia (86%), high total IgE, diffuse reticulonodular lung opacities, and mixed obstructive and restrictive pulmonary function pattern. Systemic corticosteroids were initiated for his acute respiratory insufficiency and produced rapid clinical improvement. Serum Ascaris-specific IgE was markedly elevated and he was treated with albendazole. An extensive evaluation for other infectious and allergic etiologies was negative. A site visit to the family farm and laboratory investigation was coordinated with the Louisiana Animal Disease Diagnostic Laboratory at LSU. Ascaris suum eggs were detected in fresh pig feces and in the soil immediately surrounding the pens. Ascariasis should be considered even in the absence of travel history, especially in swine raising areas that are endemic for Ascaris in pigs, such as the southeastern United States. Onychophagia is a highly probable mechanism of zoonotic fecal-oral transmission in this case, and such habits could lead to continual reinfection. Systemic corticosteroids were effective in treating the patient's acute respiratory compromise due to Löffler syndrome.

Keywords: Ascaris suum; BAL, Broncho-alveolar lavage; ED, emergency department; FEF, forced expiratory flow; FEV1, forced expiratory volume in 1 second; FVC, forced vital capacity; LPM, liter per minute; LSU, Louisiana State University; Loffler syndrome; Onychophagia; Pediatric pulmonology; Pulmonary eosinophilia; RV, residual volume; TLC, total lung capacity.

Publication types

Case Reports