A rare presentation of hydropneumothorax in tropical pulmonary eosinophilia: cavitation and pneumonic consolidation in a child

Tropical pulmonary eosinophilia (TPE) is a syndrome of wheezing, fever and eosinophilia seen predominantly in the Indian subcontinent and other tropical areas. The pathogenesis is due to an exaggerated immune response to the filarial antigens which includes type I, type III and type IV reactions with eosinophils playing a pivotal role. Leucocytosis with an absolute increase in eosinophils in the peripheral blood is the hallmark of TPE. Other criteria for the diagnosis of TPE include high titres of antifilarial antibodies, raised serum total IgE>1000ku/L and a favourable response to the antifilarial agent, diethyl-carbamazine. Although TPE runs a benign course, if left untreated, it could result in a fair degree of respiratory morbidity.