Chronic Eosinophilic Pneumonia Masquerading as Non-resolving Upper Lobe Pneumonia.

Chronic eosinophilic pneumonia (CEP) is an uncommon, idiopathic respiratory disorder characterized by the accumulation of eosinophils in the lung parenchyma and alveolar spaces, often accompanied by peripheral blood eosinophilia. Clinically, it frequently presents insidiously with non-specific symptoms such as chronic cough, mimicking infectious pneumonias. In tuberculosis (TB)-endemic regions, upper lobe consolidations routinely anchor clinicians toward mycobacterial workups, resulting in profound diagnostic delays and inappropriate antibiotic use. While bronchoalveolar lavage (BAL) or lung biopsy remains the academic diagnostic gold standard, real-world practice demands clinical flexibility when patients decline invasive interventions. We describe the case of a 65-year-old male non-smoker with a history of diabetes mellitus and hypertension who presented with a one-year history of a waxing and waning chronic cough associated with migratory ("fleeting") pulmonary infiltrates. Due to persistent right upper lobe opacities, he underwent an extensive evaluation at a specialized TB center, which rigorously ruled out active