Question

Patient presents with breathlessness and wheezing. Absolute eosinophil count is 500. Miliary pattern on CXR. Diagnosis?

• A. Miliary TB
• B. Tropical pulmonary eosinophilia
• C. Bronchial asthma
• D. Hypersensitivity pneumonitis

Hint:

The combination of wheezing, miliary CXR pattern, and elevated eosinophil count points to a filarial lung condition.

Answer 1

The Correct Option is B

Step 1: Identify key clinical features.
Breathlessness + wheezing + miliary pattern on CXR + elevated absolute eosinophil count (AEC = 500; normal <400/mm³).

Step 2: Apply differential diagnosis.

• Miliary TB: miliary pattern on CXR, but does NOT cause eosinophilia; fever, weight loss, night sweats are typical.
• Bronchial asthma: wheeze + eosinophilia possible, but miliary CXR pattern is NOT a feature of asthma.
• Hypersensitivity pneumonitis: may show miliary shadows but is typically associated with lymphocytosis, NOT eosinophilia.
• Tropical pulmonary eosinophilia (TPE): caused by microfilariae of Wuchereria bancrofti or Brugia malayi. Classic triad -- (i) nocturnal cough and wheeze, (ii) markedly elevated AEC, (iii) miliary shadows on CXR. ESR elevated. Responds to diethylcarbamazine (DEC).

Step 3: Conclusion.
The combination of wheeze + miliary CXR + eosinophilia is pathognomonic of Tropical pulmonary eosinophilia, a manifestation of occult filarial infection.