Question:medium
Patient presents with breathlessness and wheezing. Absolute eosinophil count is 500. Miliary pattern on CXR. Diagnosis?
Patient presents with breathlessness and wheezing. Absolute eosinophil count is 500. Miliary pattern on CXR. Diagnosis?
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The combination of wheezing, miliary CXR pattern, and elevated eosinophil count points to a filarial lung condition.
Updated On: Jun 23, 2026
- Miliary TB
- Tropical pulmonary eosinophilia
- Bronchial asthma
- Hypersensitivity pneumonitis
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The Correct Option is B
Solution and Explanation
Clinical reasoning approach:
Given: breathlessness, wheeze, AEC = 500/mm3, miliary pattern on chest X-ray.
Key diagnostic clue -- the triad of TPE:
Ruling out other options:
- Miliary TB: miliary shadows YES, but eosinophilia NO -- TB causes lymphocytosis.
- Bronchial asthma: wheeze + mild eosinophilia YES, but miliary CXR NO.
- Hypersensitivity pneumonitis: miliary shadows possible but eosinophilia absent; lymphocytes predominate.
Pathophysiology of TPE:
Filarial larvae (Wuchereria bancrofti) are trapped in pulmonary capillaries, triggering an intense IgE-mediated eosinophilic response. This causes miliary infiltrates and obstructive airway symptoms. Treatment is diethylcarbamazine (DEC) 6 mg/kg/day for 3 weeks.
\[\boxed{\text{Tropical Pulmonary Eosinophilia}}\]
Given: breathlessness, wheeze, AEC = 500/mm3, miliary pattern on chest X-ray.
Key diagnostic clue -- the triad of TPE:
- Nocturnal paroxysmal cough and wheeze (mimics asthma)
- Peripheral blood eosinophilia (AEC typically >3000, but can be lower early)
- Bilateral miliary or reticulonodular shadows on CXR
Ruling out other options:
- Miliary TB: miliary shadows YES, but eosinophilia NO -- TB causes lymphocytosis.
- Bronchial asthma: wheeze + mild eosinophilia YES, but miliary CXR NO.
- Hypersensitivity pneumonitis: miliary shadows possible but eosinophilia absent; lymphocytes predominate.
Pathophysiology of TPE:
Filarial larvae (Wuchereria bancrofti) are trapped in pulmonary capillaries, triggering an intense IgE-mediated eosinophilic response. This causes miliary infiltrates and obstructive airway symptoms. Treatment is diethylcarbamazine (DEC) 6 mg/kg/day for 3 weeks.
\[\boxed{\text{Tropical Pulmonary Eosinophilia}}\]
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