Beyond Eosinophilia: A Multisystem, Non-eosinophilic Löffler-Like Pulmonary Syndrome From Household Helminthic Transmission.

Löffler's syndrome is classically described as a transient pulmonary disorder associated with eosinophilic infiltration of the lungs, most commonly triggered by helminthic larval migration. While eosinophilia is considered a defining feature, rare cases lacking peripheral or pulmonary eosinophilia have been reported, complicating recognition and diagnosis. Disseminated helminthic infection with multiorgan involvement is an additional uncommon manifestation that may further obscure clinical identification. We describe a case of a 40-year-old woman with extensive environmental and animal exposure who developed pulmonary, neurologic, gastrointestinal, and cutaneous symptoms following suspected household zoonotic helminthic transmission. Despite elevated immunoglobulin E (IgE) levels and characteristic clinical features suggestive of larval migration, peripheral eosinophilia was absent. Multiple household members developed similar symptoms, supporting a shared exposure. The patient improved following empiric antihelminthic therapy and coordinated treatment of household contacts and domestic animals. This case highlights a rare non-eosinophilic variant of a Löffler-like pulmonary syndrome associated with disseminated helminthic infection and underscores the importance of considering parasitic disease in patients with multisystem symptoms and environmental exposure, even in the absence of eosinophilia.