sprint123
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106. A 60-year-old female with a history of urinary tract infection, steroiddependent
chronic obstructive lung disease, and asthma presents with bilateral
infiltrates and an eosinophil count of 15%. The least likely diagnosis is
a. Bronchopulmonary aspergillosis
b. Hypersensitivity pneumonitis
c. Strongyloides hyperinfection syndrome
d. Drug effect of nitrofurantoin
Plz explain ur answer
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| muna
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A OR D.But I prefer d.
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| AAAAA
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D
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| new_n_lost
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a. Bronchopulmonary aspergillosis Pt is Steroid Dependent & COPD & Asthma the MCC Organism is Aspergillosis. Esinophils r increased which doesnt tell u much cos Both Choices C n D will have the same reaction.
A simple of history of UTIs doesnt indicate Drug-induced Nitrofurantoin Reaction.
My 2 Cents
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| doc_clotaire
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D
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| sprint123
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Hey guys..try again....I too felt it was nitrofurantoin..BUT the answer was-Nitrofurantoin and sulphonamides are known to cause eosinophilic pneumonia!!
A clue!I was surprised by the answer
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| Adam
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Actually, i'm a little bit confused.. but after doin' an exclusion, the only answer will remain is (B).
A & D, I'm sure that they increase the eosinophils. I was confused between B and C, but Strongyloides is a parasite, and it probably will increase the eosinphils soooooooo it remains B..
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| sprint123
Forum Guru
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Yes adam..U got it!!Surprisingly,Hypersensitivity pneumonitis -eosinophilia is not a usual finding..
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| mytime
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That's coz....It's a hyper sensitivity reaction and IgE are increased and is also known as Farmer's lung disease ...... And I am late but wud have gone with B. 
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| mdwannabe
Forum Guru
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Agree with above... HP is not associated with Eosinophils ... It is IgG (precepitins) dependent.
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