When Infiltrates Wander: Case report and pragmatic approach to pulmonary migratory consolidations in a 39-year-old female

Background Eosinophilic pneumonia is a rare disorder, comprising several heterogeneous diseases. There are two major types of eosinophilic pneumonia: acute eosinophilic pneumonia and chronic eosinophilic pneumonia. In clinical practice the diagnostic approach to eosinophilic lung diseases depends predominantly on the clinical and radiologic presentation of the disease process (acute vs chronic) and the presence or absence of extrapulmonary features. Case Presentation: A 39-year-old woman presented with 6 weeks of productive cough, fever, dyspnea, diarrhea, weight loss, and marked eosinophilia after a rural travel. Initial CT showed central/anterior consolidations and mediastinal lymphadenopathy. She improved after empirical antibiotics and albendazole but relapsed with migratory consolidations. Extensive infectious, autoimmune, and oncologic workup was negative; bronchoalveolar lavage and bone marrow revealed eosinophilia. Chronic eosinophilic pneumonia was diagnosed with favorable response to corticosteroids. Conclusions This case highlights chronic eosinophilic pneumonia as an uncommon cause of migratory pulmonary consolidations and underscores the importance of a systematic exclusion-based diagnostic approach.