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


  • Poulomi Roy Department of Pediatrics, Era’s Lucknow Medical College and Hospital, Lucknow, Uttar Pradesh, India
  • Shalini Verma Department of Pediatrics, Era’s Lucknow Medical College and Hospital, Lucknow, Uttar Pradesh, India
  • Shrish Bhatnagar Department of Pediatrics, Era’s Lucknow Medical College and Hospital, Lucknow, Uttar Pradesh, India



TPE, Filariasis, DEC, Peripheral eosinophilia


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.


Mullerpattan JB, Udwadia ZF, Udwadia FE. Tropical pulmonary eosinophilia-A review. Indian J Med Res. 2013;138(3):295.

Agrawal VK, Sashindran VK. Lymphatic Filariasis in India: Problems, Challenges and New Initiatives. Med J Armed Forces India. 2006 Oct;62(4):359-62.

Ong RK, Doyle RL. Tropical pulmonary eosinophilia. Chest. 1998;113(6):1673-9.

Datta A, Chhotray P, Jena B, Sivasankar R, Sivasankar II R. A Case of Tropical Pulmonary Eosinophilia with Incomplete Response to Diethylcarbamazine Therapy. Cureus. 2023;15(1):e34359.

Santeliz JV. Tropical pulmonary eosinophilia: an epidemiological and clinical review. Int J Respir Pulm Med. 2019;6(102).

World Health Organization. Global program to eliminate lymphatic filariasis: Progress report on mass drug administration, 2014. Weekly Epidemiol Rec. 2015;90:489-504.

Vijayan VK. Tropical pulmonary eosinophilia: Pathogenesis, Diagnosis and management. Curr Opin Pulm Med. 2007;13(5):428-33.

Ray S, Kundu S, Goswami M, Mitra S. Tropical pulmonary eosinophilia misdiagnosed as military tuberculosis. A case report and literature review. Parasitol Int. 2011;69(2)381-4.

Randev S, Kumar P, Dhilon P, Jindal G, Guglani V. Tropical pulmonary eosinophilia masquerading as asthma in a five-year-old girl. Pediatrics and Intern Child Health. 2018;38(3):231-4.

Behera PK, Tripathy KP, Vats A, Sengupta P, Chaitanya Y. Tropical Pulmonary Eosinophilia Masquerading as Interstitial Lung Disease: An Interesting Case Report with Review of Literature. J Clin Diagnostic Res. 2022;16(6):11.






Case Reports