Transitory Migratory Pulmonary Infiltrations Associated With Eosinophilia (Loeffler's Syndrome) : With the Report of an Additional Case

J. WINTHROP PEABODY Chest 1944;10;391-406 DOI 10.1378/chest.10.5.391 The online version of this article, along with updated information and services can be found online on the World Wide Web at: 91

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IL 60062. Copyright 1944 by the American College of Chest Physicians. 2010 1944.chestpubs. 3300 Dundee prints. All rights reserved. It has been published monthly since 1935.chestpubs. No part of this article or PDF may be reproduced or distributed without the prior written permission of the copyright by guest on May 19. by the American College of Chest Physicians . Northbrook.xhtml) ISSN:0012-3692 Downloaded from chestjournal. ( http://chestjournal.CHEST is the official journal of the American College of Chest Physicians.

remains remarkably scanty. American College of Chest Physicians. and before a joint meeting of the Indiana and Kentucky members of the American College of Chest Physicians. 2010 1944. D. and a count derived only from titles listed in the Quarterly Cumulative Index Medicus would be most misleading. or whether the paucity of the English-American literature means unfamiliarity with the syndrome. April 15. even if all reported cases should be accepted as authentic.P. or lack of alertness in diagnosis.chestpubs. Louisville. Since Loeffler1'2 in 1932 and again in 1936 described the syndrome which has come to be known by his name. because of the lack of serial observations. for instance.A. The English and American literature on the subject. 1944. numerous cases of transitory migratory pulmonary infiltrations have been reported in the foreign literature. Washington.. Whether this apparent distribution of the disease can be accepted at its face value from the standpoint of incidence. on the other hand. I am inclined. 1944 NUMBERS Transitory Migratory Pulmonary Infiltrations Associated With Eosinophilia (Loeffler's Syndrome) * With the Report of an Additional Case J. *Presented before the North Midwest Regional District. April 16. by the American College of Chest Physicians 391 Downloaded from chestjournal. I am naturally not prepared to say. It may be significant that several of the few cases reported in it occurred in such far-off places as Hawaii and Palestine and not in North America or the British Isles.C. though even autopsy did not establish the diagnosis. Certain of them seem of very doubtful validity. Minnesota.1944. as a study of individual cases shows. F. C. Kentucky. to question the 4 autopsied cases reported by von Meyenburg. Copyright.C. 1944. WINTHROP PEABODY. in joint meeting with the Minnesota State Medical Association.P.DISEASES of the CHEST VOLUME X by guest on May 19. by the American College of Chest Physicians .. possibly associated with leukemia. My own search of the American and English literature has revealed considerably fewer than 25 cases.* Equally doubtful is the case reported by Smith and Alexander. Freund and Samuelson3 in 1940 collected from the world literature 105 cases. M. Rochester.C. including the 51 reported by Loeffler in his second communication in 1936. P.5 which concerns a child who never completely recovered from bronchopneumonia and who died of terminal sepsis.

supplemented by Breton's later description (cited by Hoff and Hicks9).392 J. Douady and Cohen (cited by Baker6) reported a case in which hemoptysis was a feature. tuberculosis was not proven and recovery was rapid. they include only mild acoustic symptoms. The clinical course is characteristically mild and the symptoms are minimal. which may be entirely normal and which seldom consist of more than a few moist and sibilant rales over the areas of consolidation.-Oct. nor is it likely to become so. as Freund and Samuelson point out. and disappear rapidly. In the two cases reported by Karan and Singer8 the symptoms were pronounced and in one instance cardiac manifestations were noted. The severity of the roentgenologic findings and the level of the eosinophilia are frequently in startling contrast to the physical findings. blood studies. that Loeffler's syndrome has been recognized only recently. for only recently have mass roentgenologic examinations been made in outpatient clinics. is to the effect that large or small consolidations appear suddenly in various parts of the lung.chestpubs. Detailed data were available in only a quarter of the 105 cases which they collected.1944 It is not surprising. roentgenologic studies. stool examinations. Roentgenologic Findings—Loeffler's original description of the roentgenologic findings. 2010 1944. climate. separate entities. Kartagener raised the question as to whether these manifestations were variants of the same disease or. schools. Discussion of the disease is still not definitive. symptomatology. Kartagener7 described a case which he classified as Loeffler's syndrome and in which chronicity was an outstanding feature. the illness lasted for several months. bronchitis. season. sometimes accompanied by sharp pains in the chest and possibly by a small production of sputum. including age. which may be very marked. by guest on May 19. these same authors observe. WINTHROP PEABODY Sept. clinical signs. sex. only to reappear elsewhere within variable pe- Downloaded from chestjournal. and elsewhere. migratory pulmonary infiltration demonstrable by roentgenologic examination and associated with eosinophilia. and possible etiologic factors. Clinical Factors—Loeffler's syndrome is best described as a transitory. by the American College of Chest Physicians . More recent writers have added to the list asthmatic attacks. He also mentioned another type of syndrome described by Lohr and by Leon-Kindberg characterized by symptoms so acute and severe as to suggest a septic process. site of the disease. and moderate temperature elevations. duration of the illness. sputum examinations. As listed by Loeffler. as seems more likely. the pulmonary infiltrations as observed serially were also slow in disappearing. and their advice is sound that physicians who encounter possible cases should take systematic histories. until cases begin to be reported in such detail that adequate critical analysis is possible.. and coughing.

They may be large or small. in which eosinophilic pneumonia is the background of the pathology. and sometimes eosinophiles were absent from the blood.11 who studied 100 cases personally. In Loeffler's cases the duration was from 3 to 8 days. pulmonary embolism with infarction. combined with bronchial spasm and resulting in localized areas of atelectasis and emphysema. however. The infiltrations are most frequently observed in the lower lung fields. with the pathogenesis similar to that of erythema nodosum. 2010 1944. bronchial asthma with atelectasis. He considered. Breton (cited by Baker) advanced the same opinion. The variability has also been explained by the variability of the supposedly responsible protein allergens. is one of Loeffler's original criteria of diagnosis. and sharply denned or vaguely outlined. and ruled out. Soderling's10 explanation is that eosinophilia is not marked when infection and fever are present. This type of pneumonia has been fully described by Miller and his by guest on May 19. and the shape is various. Such localized areas. Soderling explained the lung picture as due to stagnation of secretions in bronchitis. They sometimes bear a distinct resemblance to the adult type of pulmonary tuberculosis. as well as of many cases of supposed Downloaded from chestjournal. in many of the reported cases the eosinophilic percentage was low. Soderling also believes that the Loeffler syndrome may be the real explanation of many cases of atypical pneumonia and abortive pneumonia. irregular or circular. Pathogenesis—The most confused factor in Loeffler's syndrome is the pathogenesis. Loeffler himself concluded that the pulmonary infiltration was on an allergic basis. There is no parallelism. which 4 of his 5 patients presented. unilateral or bilateral. Eosinophilia—Although eosinophilia. the number of reported cases in the English-American literature must be still further reduced. he pointed out.12 who do not. if it is not. regard the condition as the same entity as the disease described by Loeffler. Loeffler pointed out. but tends to reappear when these manifestations have subsided. which may be at its highest level when the pulmonary infiltrations have begun to diminish. pneumonia. between the size of the roentgenologic lesion and the degree of eosinophilia. pulmonary tuberculosis. regarded the infiltration in this disease as identical with the temporary infiltrations long recognized in asthma. near the diaphragm. although the findings are always transient.Volume X LOEPPLER'S SYNDROME 393 riods of time. which is still undetermined and which is apparently multiple. may give rise to parenchymal shadows in severe attacks. sometimes accompanied by a moderately high leukocytosis and sometimes by a slightly elevated sedimentation rate. Maier. and ascariasis. and in one instance there was a recurrence at the end of a year. by the American College of Chest Physicians . Whether this disregard of Loeffler's original criteria of diagnosis is justified is open to question.chestpubs.

Muller (cited by Frimodt-Moeller and Barton13) was able to produce in himself multiple fleeting pulmonary infiltrations. Beck15 reported a clearcut case of Loeffler's syndrome in which he observed dramatic clinical improvement. however. roentgenologic examination showed massive pulmonary consolidations.394 J. by eating material containing Ascaris ova and suggested that the roentgenologic shadows may be caused directly by the passage of Ascaris larvae through the lungs. Opinions differ as to precisely how the pathologic changes are brought about. A similar morbid picture was observed in another patient.-Oct. though intestinal parasitism. Other writers have accepted them less wholeheartedly. which on the surface seems more reasonable. Engel (cited by Soderling) reported an epidemic cough which occurs in the general population in China in May and June.chestpubs. WINTHROP PEABODY Sept. with associated by guest on May 19. Baer. after they have penetrated into the liver through the intestinal wall. whose eosinophilia. mentioned a zoologist of his acquaintance who developed severe rhinitis and conjunctivitis if he so much as walked across a laboratory in which ascarids were being worked on. is that the pulmonary changes are indirect and represent an allergic reaction to the presence of ascarids in the body. has most frequently been indicted. with apparent reason. however. Engel conceived of the lung changes as a Quincke's edema and proposed for the disease the name "oedema allergicum pulmonis. by the American College of Chest Physicians . when the privet is in flower.14 for instance. 2010 1944. Cause and effect reasoning also substantiates the theory that parasitism is responsible for Loeffler's syndrome. disappearance of urticaria. Downloaded from chestjournal.. and regression of the pulmonary infiltration following treatment by crystalloids of intestinal infestation with Strongyloides intestinalis and Ascaris lumbricoides. 1944 tuberculosis in which recovery takes place rapidly. On two occasions when he himself developed such a cough. The pulmonary infiltration disappeared within 24 hours in the first attack and within 6 days in the second. was only 6 per cent. the etiologic agent (or agents) responsible have not been identified. It is acknowledged that reactions of this sort may be violent. Stefano (cited by Hoff and Hicks) reported a case of recurrent asthmatic attacks associated with transient areas of pulmonary infiltration. Another theory." Soderling regards Engel's observations as next in importance to Loeffler's and spoke of the disease as the Loeffler-Engel syndrome. The possibility of such a migration has been demonstrated by Japanese workers. In most cases. Emetine therapy cured the infestation and the patient was simultaneously completely relieved of his asthma. in which amebae were found in the sputum though not in the stools. associated with eosinophilia of 20 to 25 per cent. It is now generally believed that the disease develops on an allergic basis.

the course of which was practically always so mild that treatment was not required. the institution of certain forms of treatment for tuberculosis. which the former does not. as has been noted. If therapy should prove necessary. Films must be made at frequent intervals. (3) The degree of eosinophilia. Indeed. the severity of which is out of all proportion to the insignificance of the physical findings and the mildness of the clinical course. The differentiation of Loeffler's syndrome from tuberculosis is extremely important. such as pneumothorax. the patient being completely and simultaneously relieved of his asthma and his intestinal infestation. the categoric statement may be made that if. Therapy—It will be noted that in all the reported cases the therapy was directed toward the allergic manifestations rather than toward the Loeffler syndrome itself. for diagnosis cannot be made upon a single investigation. and the consistent failure to find acid fast bacilli in the by guest on May 19. The patient had had severe asthmatic attacks for 3 months. however. Diagnosis—The diagnosis of Loeffler's syndrome rests upon three considerations: (1) The radiologic picture. For one thing. It is excluded by the variations in the roentgenologic shadows. Although treatment with anayodin resulted in only slight improvement. the response to emetine was dramatic. the persistence of which raises doubt as to the diagnosis. that amebiasis rather than the privet flower might have been revealed as the etiologic agent. Loeffler's advice that examinations be made every second day represents an ideal rather than a practical plan. the disease is not tuberculosis. the prompt disappearance of the pathologic changes. after adequate tests. (2) The transience of the roentgenologic findings. the latter disease demands a regimen of life. by the American College of Chest Physicians . These authors speculate that if stool and sputum examinations had been carried out in the cases reported by Engel. with all its social and economic implications. which. cannot be correlated in respect to chronology with the severity of the pulmonary changes as demonstrated by x-ray. it is quite possible.Volume X LOEPPLER'S SYNDROME 395 Hoff and Hicks reported a case of this syndrome associated with Endoemba histolytica infestation.16 Tuberculosis. in view of the frequency of amebic infestation in China. 2010 1944. Baer notes that a single film in his case suggested neoplasia and others have called attention to the similarity between the roentgenologic picture in this disease and in coccidioidomycosis. could readily give rise to disastrous consequences in a non-tuberculous subject. Downloaded from chestjournal. and eventually presented a clinical picture suggestive of early amebic hepatitis. as described by Dickson. doses is recommended by Engel (cited by Soderling). For another. calcium lactate in 3 gm.chestpubs. presents the greatest difficulty in differential diagnosis. tubercle bacilli cannot be found in the sputum or the gastric secretion.

by the American College of Chest Physicians . 1944 Downloaded from chestjournal.396 by guest on May 19. 2010 1944. WINTHROP PEABODY Srpt.chestpubs.-Oct.

. mm. Urinalysis was always essentially negative. The differential count showed 48 per cent eosinophiles. The white blood cell count and the differential count. James Nolan was asked to investigate the allergic state and has continued to direct the treatment ever since. possibly of tuberculous origin. are summarized at this point. per hour. which varied from moderate to marked. March 16. The patient disregarded both pieces of advice. Dr. at which time he was suffering from an asthmatic attack (his first) of such severity that he was hospitalized at once. and which were always substantially the same.450 per cu. The tuberculin patch test and the Mantoux test were negative. The past history was without incident except for the usual diseases of childhood (measles. 1942. 1942.000 per cu. although examined by smear. varied considerably at different periods of the illness. the case reported herewith seems to fit into the syndrome described by Loeffler. mm. the white blood cell count was 14.200. The essential facts follow: M. diabetes. 1942. Time and space will be saved if certain laboratory examinations which were carried out at this time and during the subsequent 23-month period of observation. 2010 1944. For the past 6 months he had suffered from. chickenpox and whooping cough) and appendectomy for acute disease at the age of 9 years. renal and cardiac disease. B.chestpubs. Stereoscopic examination of the chest revealed the bilateral lesions previously described. 1942. Pluoroscopic examination April 24. however. probably of tuberculous origin. extending from the level of the third rib anteriorly to the level of the fifth rib. "a very bad cold" and moderately productive cough. All other illnesses were specifically denied. and continued observation was advised until a positive diagnosis could be made. was first seen in consultation March 16. 32 per cent segmenters. Examination of a stool specimen March 16. The sputum. A contemplated marriage was also advised against. and the only findings of significance was an eosinophilia. the patient was told that he apparently had an active pulmonary infection. When he first sought medical advice from his family physician. as were all the skin tests carried out at various times during the illness. Downloaded from chestjournal. more marked on the left side. and the family history was specifically negative for cancer. revealed clear lung fields. a white male government clerk 21 years of age. but all subsequent stool examinations were negative. and allergic states. which were now somewhat less extensive. The findings had been interpreted as an acute infection in both upper lobes. Physical examination at this time was essentially negative. concentration and culture at various times. and 3 per cent myelocytes. He was not seen again until July by guest on May 19.Volume X LOEFFLEB'S SYNDROME 397 CASE REPORT All things considered. associated with a slight loss of weight and a sense of fullness and later of soreness in the chest. roentgenologic examination of the chest had revealed an infiltration in both lungs. by the American College of Chest Physicians . The sedimentation rate varied between 13 and 24 mm. never revealed acid fast bacilli. but in view of his recent history and the previous roentgenologic findings. 1942. and entirely neglected until 2 weeks earlier. Stereoscopic examination of the chest at this time again revealed no abnormalities. revealed larvae of Ascaris lumbricozdes. 17 per cent lymphocytes. The hemoglobin was never lower than 78 per cent and the red blood cells never numbered less than 4. tuberculosis.

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musical rales throughout the chest. 1943. Physical examination was negative except for many moist. The patient was again seen in consultation August 9. mm. there were 29 per cent polymorphonuclear leukocytes. The paralysis gradually disappeared.600 per cu. Despite the change of climate his asthmatic attacks continued. Another triangular area of dense infiltration was observed in the right upper lobe. at first every day or two.Volume X LOEPPLER'S SYNDROME 399 The patient was discharged from the hospital at the end of a week. A diffuse. The white blood cells numbered 14. 12 per cent lymphocytes. because of the severity and frequency of his asthmatic attacks. The temperature ranged between 100° and 102° F.800 per cu. Shortly after his discharge from the hospital the patient went to Florida. A decision as to activity was withheld pending further clinical observation and laboratory investigation. and 1 per cent monocytes. Stereoscopic examination of the chest January 6. The patient was hospitalized for the second time March 7. but there was no other marked elevation during the illness and seldom any elevation at all. though the physical examination was again essentially negative. Psychiatric examination.450 per cu. and 16 per cent lymphocytes. The heart was somewhat retracted to the left as the result of the fibrotic changes. 48 per cent polymorphonuclear leukocytes. furnished no diagnostic aid. revealed essentially the same findings as on August 6. 2010 1944.chestpubs. The white blood cell count August 9 was 17. 7 per cent lymphocytes. 2 per cent basophiles. chiefly in the form of wheezing and dyspnea. undertaken because of a mental and emotional strain to which the patient had recently been subjected. Repetition of the stereoscopic examination August 9.1943. Soon after leaving the hospital he developed anesthesia of the dorsum and palm of the left hand. The only other symptom was anorexia. with paralysis and anesthesia of the fourth and fifth fingers of the same hand. with 36 per cent eosinophiles. somewhat more marked at the left apex. but continued to have attacks of asthma.1943. between the second and third ribs anteriorly. mm. 1943. The patient was hospitalized for the third time August 26. then every 6 or 8 hours. predominantly fibrotic infiltration of the upper lobe on this side enclosed several radiolucent shadows simulating cavities. possibly as the result of the adrenalin therapy used to control the asthmatic attacks. where he spent 4 months and where he had no medical supervision. again showed the lung fields clear. and 70 per cent segmenters. They were interpreted as indicative of thickening of the pleura and bilateral fibroid tuberculosis. 1943. Stereoscopic examination of the chest August 6 had revealed a homogeneous density overlying the lateral portion of the left lung and extending from the apex to the seventh rib by guest on May 19. Both bases were relatively clear. mm.. for an acute upper respiratory infection and continued attacks of asthma. and the eosinophilia to 63 per cent. The findings were now interpreted as indicative of a severe infectious process with a marked allergic reaction. 2 per cent stabs. by the American College of Chest Physicians . The differential count showed 14 per cent eosinophiles. for several days. Stereoscopic examination of the chest August 27 showed the right lung Downloaded from chestjournal. and eventually every 2 hours. In the year since their onset he had lost between 35 and 40 pounds and he now looked very ill. Two days later the white blood cell count had risen to 23. but the patient continued to complain of numbness over the affected areas and of pain along the course of the ulnar nerve.

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since the patient frequently disappeared from observation.. on the first examination and 11.800 per cu. The entire left lung field was occupied by an extensive fibrotic and infiltrative process. though I must grant that when I first saw the patient Downloaded from chestjournal. The patient was not seen again until February 14. 1944. in the light of the history and clinical course were now interpreted as probably due to some type of fungous infection. 72 per cent segmenters. and 9 per cent lymphocytes. The white blood cells numbered 15. and which at intervals disappeared entirely. The changes were sometimes observed within a few days and sometimes at long intervals. which. 5) The presence of larvae of Ascaris lumbricoides in the stool on a single examination but the repeated failure to find them in subsequent examinations over a 23-month period which would seem to exclude this parasite as the etiologic agent in this special case. as throughout the illness. 1943. always temporary. though the length of the interims is perhaps not significant. on the second. with 19 per cent eosinophiles. I have consistently opposed the diagnosis of pulmonary tuberculosis. which at one time reached 63 per cent and which was never lower than 14 per cent. concentration. Another examination September 3. The differential blood count August 26 showed 61 per cent eosinophiles. showed substantially the same roentgenologic findings. the allergist reports. mm. At times the chest presents physical findings typical of asthma. and an area of decreased density in the infraclavicular region was regarded as a possible by guest on May 19.200 white cells per cu. which. The hemogram showed 11.Volumes LOEFPLER'S SYNDROME 401 clear. except for certain changes to be expected in severe asthma. amounted to little more than the occasional appearance of rales. the physical examination is essentially negative. It is worth pointing out in this connection that although the films were made in three different laboratories. Adrenalin gives the most satisfactory results. at which time stereoscopic examination showed the lung fields clear. 3) The insignificant character of the physical findings. and culture.chestpubs. has not yet been identified in spite of exhaustive tests. COMMENT There are several striking features in this case: 1) The high degree of eosinophilia. the three roentgenologists were in accord in their interpretations. 2010 1944. My personal role in this case has been that of chest consultant. to find acid fast bacilli in the sputum. As such. although they were suggestive of tuberculosis. which varied as to location. the cause of which. migratory character of the pulmonary infiltration. mm. as well as the negative results of the tuberculin patch and Mantoux tests. but they are. which variously involved one lung and both lungs. but usually. by the American College of Chest Physicians . September 4 the eosinophilia had fallen to 41 per cent. The patient is still under treatment for asthma. 4) The failure on repeated examinations by smear. mm. Treatment has been entirely symptomatic.600 per cu. 2) The definitely transitory. of course.

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Se duda seriamente que todos los casos presentados scan verdaderos ejemplos de este sindrome.chestpubs. by the American College of Chest Physicians . 2010 1944. the disease. 5) An additional case of Loeffler's syndrome is herewith added to the American literature of the subject. a large number of cases have been reported in the foreign literature and a small number in the English-American literature.Volume X LOEFFLEB'S SYNDROME 403 the history and roentgenologic findings strongly pointed to this conclusion. Whether all of the reported cases are true instances of the syndrome is open to decided doubt. La gravedad de los hallazgos roentgeno!6gicos presenta Downloaded from chestjournal. however. Loeffler's syndrome. as already by guest on May 19. demostrable mediante examen roentgeno!6gico y asociada con eosinofilia que puede ser muy marcada. 3) The pathogenesis is still undetermined. The present impression. migratory pulmonary infiltration. and the degree of eosinophilia. RESUMEN 1) Desde cuando se describi6 por primera vez el sindrome de Loffler en 1932. is positively not tuberculosis. and intestinal parasitism has been identified as the causative agent in the few cases in which any identification at all has been possible. is that the condition is a marked allergic reaction secondary to some severe infectious process. which may be very marked. in itself seldom requiring treatment. ha aparecido un gran numero de casos en la literatura extranjera y un pequeno numero en la literatura anglo-americana. Therapy is directed toward the allergic disease. 2) La mejor descripcion del sindrome es que este es una infiltracion pulmonar transitoria y migratoria. It cannot be made upon a single film. Pulmonary tuberculosis is the most frequent differential diagnostic consideration. but the disease is now generally believed to develop on an allergic background. the cause of which is yet to be determined but the manifestations of which seem to place the case among the few instances of Loeffler's syndrome so far observed in this country. and to the minor symptomatology and mild clinical course. the transience of the roentgenologic findings. My personal conviction. 4) Diagnosis rests upon the radiologic picture. which is frequently entirely negative. and for therapeutic reasons the differentiation is extremely important. demonstrable by roentgenologic examination and associated with eosinophilia. whatever it may prove to be. 2) The syndrome is best described as a transitory. is that if acid fast bacilli cannot be demonstrated in the sputum. The severity of the roentgenologic findings is in surprising contrast to the physical examination. SUMMARY 1) Since Loeffler's syndrome was first described in 1932.

1944 Downloaded from chestjournal. WINTHROP PEABODY by guest on May 19.-Oct.chestpubs.404 J.. 2010 1944. by the American College of Chest Physicians .

Volume X LOEFFLER'S SYNDROME 405 r J Downloaded from by guest on May 19. 2010 1944. by the American College of Chest Physicians .

3 Freund..: "Zur Differential-Diagnose der Lungeninfiltrierungen. (Oct. C. y la diferenciaci6n es en extreme importante por razones terapeuticas. Downloaded from chestjournal. (Oct." J. 5 Smith. 4) El diagn6stico esta basado en el cuadro radiolbgico. M. Se dirige el tratamiento hacia la enfermedad alergica. d. M. H. M.. Child." J. 8) 1938.. D. Med.1944 un contraste sorprendente con el examen fisico... Wchnschr. A. 121: 626.. Hyman. With a Report of Five Cases.: "Eosinophilie Pulmonary Infiltration: Pathologic Anatomy and Pathogenesis." Hawaii M. 13 Frimodt-Moeller. (Dec.. S." Arch. J.: "Temporary Eosinophilie Pulmonary Infiltration: Summary of More than One Hundred Observations.. J. A. A." Ann. M. 66: 1215. and Samuelson. (Feb. A. A.. 14 Baer. No puede establecerse con una sola pelicula.. (July) 1942.) 1941. 2 Loeffler.. z. George. C. J.: "Allergic Bronchopneumonia. H.) 1935. A. Emanuel: "Transitory Pulmonary Infiltrations Mistaken for Tuberculosis. W. and Barton.. A. Amanda. A. Med. C. 10: 95. Arthur: "Report of a Case of Transient Pulmonary Edema (Loeffler's Syndrome). M. Abstract in J. A. 72: 862.) 1940. Int." Schweiz. pero se cree comunmente que se desarrolla en un fondo alergico y el agente etio!6gico identificado ha sido parasitismo intestinal en los pocos cases en los que ha sido posible hacer la identificacidn. Abstract in J. M. and Singer. Gaz.406 J. 123: 869." Helvet. A.) 1940. acta. S. REFERENCES 1 Loeffler. C. Ben F. 12 Miller. 66: 1069. y con la sintomatologia menor y la benigna evolucidn clinica. 40: 494. que con frecuencia es enteramente negative. Wchnschr. J. M.-Oct. 16 Dickson. C. Klin. (Dec. el sindrome de Loffler de por si. 121: 893.. (July) 1942. 32: 267. 4 von Meyenburg.. by the American College of Chest Physicians .: "Transitory Lung Infiltrations Associated With Eosinophilia (Loeffler's Syndrome): Report of a Case. A. L. and Friedman. 37: 960. Ill: 1362. 7 Kartagener. s61o en raras ocasiones requiere tratamiento. 2010 1944. 14: 22. WINTHROP PEABODY Sept. R. by guest on May 19." South. (March) 1939. C. E. 20) 1943. (April) 1943. Wchnschr. W. 17: 106." Schweiz.. Pediat. Tuberc. (Oct. med. 8) 1942.1932." Beilr. T. (Nov.. 8 Karan. Tuberk. R.: "Chronic Pulmonary Infiltration With Eosinophilia. med. 72: 809 (July 25) 1942. Mason: "Transient Pulmonary Infiltrations: A Case With Eosinophilia (Loeffler's Syndrome) Associated With Amoebiasas. A. (March 13) 1943.. 1939.: "Transitory Infiltration of the Lung With Eosinophilia: Loeftier's Syndrome. 10 Soderling. W." Canad.chestpubs.: "Die fluchtigen Lungeninfiltrate mit Eosinophilie. B.: "A Pseudo-tuberculous Condition Associated With Eosinophilia. (Feb.: "Transitory Lung Infiltrations Associated With Eosinophilia. (May) 1939. Feingold. 11 Maier. Rev. (Nov. 75: 607." Am. and Alexander..." Arch. 6 Baker. Bertll: "Transient Lung Consolidation in Asthmatic Children With Reference to Eosinophilia. Piness. 7: 768.. Dis. 89: 368. Int. 27) 1943." Indian M.) 1942. 1: 361... Abstract in J. M. 15 Beck.. 9 Hof f. med. 45: 194. 3) No se ha determinado todavia la patogenia." Schweiz. 5) Se agrega otro caso del sindrome de Loffler a la literatura americana sobre esta materia. (Aug. and Hicks. Se considera mas frecuentemente a la tuberculosis pulmonar en el diagnostico diferencial..: "The Loeffler Syndrome: Report of a Case. J.: "Coccidioidomycosis: The Preliminary Acute Infection With Fungus Coccidioides. en lo transitorio de los hallazgos roentgenoldgicos y en el grado de eosinofilia." Ohio State M. 7) 1936.

or g/content/10/5/391 Information about reproducing this article in parts (figures. Figures that appear in CHEST articles can be downloaded for teaching purposes in PowerPoint slide c/reprints.5.391 This information is current as of May 19.chestpubs.chestpubs.1378/chest.xhtml Information about ordering reprints can be found online: by guest on May 19. by the American College of Chest Physicians . WINTHROP PEABODY Chest 1944. tables) or in its entirety can be found online at: http://www.10. 391-406 DOI 10.chestpubs.Transitory Migratory Pulmonary Infiltrations Associated With Eosinophilia (Loeffler's Syndrome) : With the Report of an Additional Case J.xhtml Receive free e-mail alerts when new articles cite this article. 2010 1944. To sign c/reprints. 2010 Updated Information & Services Updated Information and services can be found at: http://chestjournal.10. select the "Services" link to the right of the online article. See any online figure for directions. Permissions & Licensing Reprints Citation Alerts Images in PowerPoint format Downloaded from chestjournal.

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