A Retrospective Review of 193 Cases of Severe Eosinophilia in the Northeast United States

Lam, Barbara D.; Hale, Andrew J.; Bullis, Sean; He, Yuting; Khan, Sundas; Freed, Jason A.

doi:10.1016/j.amjmed.2020.11.022

Cited by 3 publications

(3 citation statements)

References 12 publications

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“…Second, the single largest group of diagnosed subjects has malignant diseases. This finding has been reported rarely [6,7], while a recently published case study supports this observation [8].…”

Section: Severe Eosinophilia In Hospitalized Patientssupporting

confidence: 78%

Severe eosinophilia in hospitalized patients

et al. 2021

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Section: Severe Eosinophilia In Hospitalized Patientssupporting

confidence: 78%

Severe eosinophilia in hospitalized patients

et al. 2021

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“…Clinically speaking, various phenotypes can take place, from acute fatal myocarditis to chronic heart failure passing through acute myocardial infarction and valvular regurgitation. There is some disagreement as to whether the severity of eosinophilia is related to its clinical manifestations [14]. There have been cases described of severe eosinophilia without any organ damage or even symptoms, as well as mild or absent eosinophilia with fatal complications related to eosinophil organ infiltration.…”

Section: Discussionmentioning

confidence: 99%

Pulmonary Adenocarcinoma Presenting as Acute Heart Failure and Hypereosinophilia

Ferrão¹,

Silva²,

Almeida³

2022

Cureus

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Hypereosinophilia is a serum eosinophil count of over 1,500 eosinophils/µL. It is an uncommon laboratory finding, and it can be asymptomatic or associated with organ damage, in which case it is referred to as hypereosinophilic syndrome. It can be primary, when the expansion of eosinophils occurs in the setting of a hematological neoplasm, or secondary, when it is caused by an external stimulus, such as a parasitic infection or a solid neoplasm. We present a case of hypereosinophilia diagnosed in a patient presenting with acute heart failure initially attributed to coronary disease and alcohol consumption. Due to persisting eosinophilia with no apparent cause, eventually reaching more than 41,000 eosinophils/µL, a full-body scan was performed, showing the presence of a peri-hilar mass partially obstructing the left main bronchus and multiple lesions in the liver and thoracic vertebrae. The liver biopsy revealed metastatic non-small cell lung carcinoma. Around the time the biopsy was performed, the patient began complaining of new-onset chest paint, and the diagnoses of pulmonary embolism and later lung abscess were made, the reasons why he had no conditions to begin chemotherapy. The medical condition of the patient deteriorated in the next few days, and the patient died six months after the initial diagnosis of hypereosinophilia.

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“…A potential beneficial role may be explained by the secretion of various enzymes and cytokines by eosinophils that influence tumor immunity and reduce tumor progression ( 114 ). Severe blood eosinophilia during symptom development may be a diagnostic clue for malignancy and therefore guide the diagnostic process ( 115 , 116 ). Results indicate that blood eosinophilia may be a positive prognostic factor in some malignant solid tumors, when present ( 113 , 117 ), whereas the presence of blood eosinophilia after surgical resection may indicate an unfavorable prognosis, relapse, or rapid disease progression ( 118 ).…”

Section: Review Of the Eosinophil Granulocyte In Health And Diseasementioning

confidence: 99%

The multidisciplinary approach to eosinophilia

et al. 2023

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Eosinophilic granulocytes are normally present in low numbers in the bloodstream. Patients with an increased number of eosinophilic granulocytes in the differential count (eosinophilia) are common and can pose a clinical challenge because conditions with eosinophilia occur in all medical specialties. The diagnostic approach must be guided by a thorough medical history, supported by specific tests to guide individualized treatment. Neoplastic (primary) eosinophilia is identified by one of several unique acquired genetic causes. In contrast, reactive (secondary) eosinophilia is associated with a cytokine stimulus in a specific disease, while idiopathic eosinophilia is a diagnosis by exclusion. Rational treatment is disease-directed in secondary cases and has paved the way for targeted treatment against the driver in primary eosinophilia, whereas idiopathic cases are treated as needed by principles in eosinophilia originating from clonal drivers. The vast majority of patients are diagnosed with secondary eosinophilia and are managed by the relevant specialty—e.g., rheumatology, allergy, dermatology, gastroenterology, pulmonary medicine, hematology, or infectious disease. The overlap in symptoms and the risk of irreversible organ involvement in eosinophilia, irrespective of the cause, warrants that patients without a diagnostic clarification or who do not respond to adequate treatment should be referred to a multidisciplinary function anchored in a hematology department for evaluation. This review presents the pathophysiology, manifestations, differential diagnosis, diagnostic workup, and management of (adult) patients with eosinophilia. The purpose is to place eosinophilia in a clinical context, and therefore justify and inspire the establishment of a multidisciplinary team of experts from diagnostic and clinical specialties at the regional level to support the second opinion. The target patient population requires highly specialized laboratory analysis and therapy and occasionally has severe eosinophil-induced organ dysfunction. An added value of a centralized, clinical function is to serve as a platform for education and research to further improve the management of patients with eosinophilia. Primary and idiopathic eosinophilia are key topics in the review, which also address current research and discusses outstanding issues in the field.

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A Retrospective Review of 193 Cases of Severe Eosinophilia in the Northeast United States

Cited by 3 publications

References 12 publications

Severe eosinophilia in hospitalized patients

Severe eosinophilia in hospitalized patients

Pulmonary Adenocarcinoma Presenting as Acute Heart Failure and Hypereosinophilia

The multidisciplinary approach to eosinophilia

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