Parikshit Haridas Thakare 1 , Ketaki Vasudev Utpat 2 , Unnati Deepak Desai 3 , Jyotsna Madanmohan Joshi

PRESENTATION OF CASE Tropical Pulmonary Eosinophilia (TPE) is a peculiar syndrome of wheezing, fever and eosinophilia seen predominantly in the Indian subcontinent and other tropical areas. Peripheral blood eosinophilia with levels over 3000/μL and elevated serum levels of IgE and filarial-specific IgE and IgG are the hallmark features. Treatment consists of diethylcarbamazine (DEC) for at least 3 weeks. Prognosis is good with opportune treatment. However, despite optimum treatment with DEC, about 20% of patients may relapse and require retreatment with DEC or alternative management. This concept needs to be taken cognisance of whilst contemplating further management and disease prognostication. Tropical Pulmonary Eosinophilia (TPE) is an eosinophilic lung disease associated with a hypersensitivity response to microfilariae of the parasites, Wuchereria bancrofti and Brugia malayi. 1 It is fairly common in areas with filarial endemicity including regions of the Indian subcontinent, South East Asia, South America and Africa. It frequently occurs in the age group of 15-40 years with a male:female ratio of 4:1. 1 The criteria for diagnosis of TPE include residence in an area endemic for filariasis, symptoms of recent onset of paroxysmal nocturnal cough with or without sputum, absolute blood eosinophil count of 2,000/µL or above, absence of circulating microfilaria in blood and successful clinical and haematological remission with Diethylcarbamazine (DEC) therapy. 1 The standard treatment is DEC given in the dose of 3-5 mg/kg bodyweight for a duration of 3 weeks. However, failure rates of approximately 20-40% have been reported with DEC therapy. 2 Though usually considered an acute and treatable disease, a chronic state has also been described in TPE. 2 We herein report a patient who continued to have persistently elevated eosinophil counts despite of being adequately treated with DEC therapy and also had clinical flare up of the disease. He was managed with DEC therapy again with normal eosinophil counts on subsequent follow up.