Tropical pulmonary eosinophilia masquerading as asthma in a 5-year-old girl

Tropical pulmonary eosinophilia (TPE) is an exaggerated immunological response to filarial antigens mainly seen in adults in endemic areas and is uncommonly reported in children. The diagnosis is frequently delayed as it mimics asthma clinically, while the chest radiograph might show miliary mottling which is often confused with that in pulmonary tuberculosis. A 5-year-old girl presented with episodes of nocturnal cough, wheeze, low grade fever and breathlessness for the previous 4 months and was being treated for asthma. The absolute eosinophil count was markedly raised (53 × 10⁹/L) with prominent bilateral infiltrates on the chest radiograph. Serology for microfilaria and a test for microfilaria antigens were positive and the patient showed a dramatic response to diethylcarbamazine, which confirmed the diagnosis of TPE. TPE is an important differential diagnosis of asthma especially in endemic areas.