Question

All the following diseases are associated with peripheral blood eosinophilia except:

• A. Allergic bronchopulmonary aspergillosis (ABPA)
• B. Loeffler's syndrome
• C. Pulmonary eosinophilic granuloma
• D. Churg-Strauss syndrome

Hint:

Think about which disease's 'eosinophilic' name refers to tissue findings on biopsy rather than a raised blood eosinophil count.

Answer 1

The Correct Option is C

Step 1: Understanding the Question:
The question asks which of the four conditions listed is NOT typically linked with a rise in eosinophils in the peripheral blood.

Step 2: Key Concept:
Peripheral blood eosinophilia is seen in a group of pulmonary eosinophilic disorders, which include ABPA, simple pulmonary eosinophilia (Loeffler's syndrome), chronic eosinophilic pneumonia, tropical pulmonary eosinophilia, and Churg-Strauss syndrome (now called eosinophilic granulomatosis with polyangiitis). Pulmonary eosinophilic granuloma, despite its name, is a form of pulmonary Langerhans cell histiocytosis and is not part of this eosinophilic lung disease group.

Step 3: Detailed Explanation:
Option (A), ABPA is a hypersensitivity reaction to Aspergillus in the airways and it drives a strong peripheral and pulmonary eosinophil response along with a raised IgE. Option (B), Loeffler's syndrome is a transient pulmonary infiltrate caused by migrating larvae (commonly Ascaris) and it also raises peripheral eosinophil counts. Option (D), Churg-Strauss syndrome is a small vessel vasculitis with asthma and marked blood eosinophilia as one of its defining features. Option (C), pulmonary eosinophilic granuloma is Langerhans cell histiocytosis of the lung. It is a smoking-related clonal proliferation of Langerhans cells, and the name "eosinophilic granuloma" comes from the eosinophils seen inside the tissue granuloma on biopsy, not from a rise in the blood eosinophil count. Peripheral blood eosinophilia is not a typical feature of this disease.

Step 4: Final Answer:
Pulmonary eosinophilic granuloma is the one condition among the four that is not linked with peripheral blood eosinophilia, so the correct answer is option (3), Pulmonary eosinophilic granuloma.