Eosinophilic Vasculitis: Time for Recognition of a New Entity?

Law, Arjun; Varma, Subhash; Varma, Neelam; Khadwal, Alka; Prakash, Gaurav; Suri, Vikas; Kumari, Savita; Malhotra, Pankaj

doi:10.1007/s12288-014-0384-2

Cited by 10 publications

(11 citation statements)

References 21 publications

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“…Peripheral eosinophilia can be seen in helminthic infection, allergic disease, hematologic/myeloproliferative disorders, Wells syndrome, eosinophilic granulomatosis with polyangiitis, recurrent cutaneous necrotizing eosinophilic vasculitis, and hypereosinophilic syndrome 7, 8. Cutaneous manifestations of hypereosinophilia include angioedematous and urticarial lesions, erythematous and pruritic papules/nodules, vesiculobullous eruptions, ulcerations with dermal arteriolar microthrombi, and generalized erythroderma, presenting a unique diagnostic challenge 2 …”

Section: Discussionmentioning

confidence: 99%

“…This case shows retiform purpura with peripheral eosinophilia and vascular occlusion rapidly progressing to tissue necrosis and gangrene. Given the lack of definitive vessel wall pathology with negative results for antineutrophil cytoplasmic antibody, cryoglobulin, antinuclear antibody, rheumatoid factor, erythrocyte sedimentation rate, and C3/C4 tests, vasculopathy from hypereosinophilia and prothrombotic activity was favored over primary eosinophilic vasculitis, the latter of which generally occurs in middle-aged Asian men and is associated with retiform purpura from arteriovenous thrombosis 8 …”

Section: Discussionmentioning

confidence: 99%

“…Thrombosis in IHES may be related to significant longstanding eosinophil activation leading to degranulation of tissue factor–containing granules 1, 2, 8. Suggested mediators include eosinophilic cationic protein, which enhances factor XII activity and binds endogenous heparinoids, and major basic protein, which causes direct endothelial damage and collagen exposure 8 . Although high-dose steroids resolved inflammation, vasodilation and anticoagulation were unsuccessful in halting thrombosis 8 .…”

Section: Discussionmentioning

confidence: 99%

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Skin-limited idiopathic hypereosinophilic syndrome presenting with retiform purpura

Dee

Menge

et al. 2019

JAAD Case Reports

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Skin-limited idiopathic hypereosinophilic syndrome presenting with retiform purpura

Dee

Menge

et al. 2019

JAAD Case Reports

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“…In majority of HES, exact cause is not known and is grouped under idiopathic HES [2,3]. Idiopathic HES may be associated with arteriovenous thrombosis and eosinophilic vasculitis [4].…”

Section: Discussionmentioning

confidence: 99%

Hypereosinophilia in a Young Patient: Occam’s Razor or Hickam’s Dictum?

Lakshman

Nampoothiri²,

Law³

et al. 2014

Indian J Hematol Blood Transfus

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Hypereosinophilia is an uncommon clinical problem encountered in hematology practice. While most of such cases are secondary or reactive, a significant fraction of cases are due to clonal myeloproliferative disorders. We report a young patient who presented with marked hypereosinophilia and was investigated extensively for its cause. Finally a common tropical infection was responsible for such marked eosinophilia fulfilling the principle of Occam's razor. The case emphasizes the need to search for treatable reactive causes even in presence of marked hypereosinophilia in a tropical country.

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“…In this case, medical history of asthma and lung involvement that are documented in the American College of Rheumatology classification criteria and the Chapel Hill consensus conference definition for EGPA were lacking 3 4. However, given the evidence of eosinophilia with elevated IgE and perivascular eosinophilic infiltration in granulomatous inflammation of dermis on biopsy, multidisciplinary discussion led to the diagnosis of EGPA or a rare entity of eosinophilic vasculitis with thrombotic complication 5. It is recognised that eosinophilic vasculitis is responsive to corticosteroid therapy.…”

Section: Answer: Bmentioning

confidence: 99%

Finger necrosis with eosinophilia and symmetrical occlusion of the peripheral artery

Nishikawa

Hirano

Kawarada³

2019

Heart Asia

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Case presentationA 59-year-old man with hypertension, dyslipidemia and a current smoking history had presented with bilateral painful finger ulcers (figure 1A). The patient was referred to our hospital for the diagnosis and treatment. On his arrival, his fingers showed the development from ulcer to necrosis during the 3 weeks (figure 1B). Diagnostic angiography at the previous hospital had revealed symmetrical occlusions of the forearm and crural arteries (figure 2). Laboratory blood tests demonstrated an eosinophilia (21 %, 1743 cells/µL) with marked elevation of IgE (4200 mg/dL) as well as inflammatory reaction such as erythrocyte sedimentation rate 84 mm/h and C-reactive protein 0.85 mg/dL. There was no evidence of thrombophilia, and autoantibodies were negative. A skin biopsy from the border of the necrosis demonstrated perivascular considerable infiltration of inflammatory cells including eosinophils (figure 3).Figure 1(A) Initial manifestation at the previous hospital. Note the ulcers in the bilateral fingers. (B) Development to finger necrosis on his admission in our hospital.Figure 2(A) Upper extremity angiography revealed extensive occlusions in the bilateral radial and ulnar arteries (arrow). (B) Lower extremity angiography revealed multiple occlusions in the right anterior tibial artery, the left anterior tibial artery and the left posterior tibial artery (arrow).Figure 3(A) Skin biopsy from the border of the finger necrosis demonstrated nodular inflammatory cell infiltration in dermis and subcutaneous tissue (H&E stain). (B) Magnified histopathological examination of the skin biopsy found eosinophilic infiltration (arrows) in granulomatous inflammation of upper dermis (H&E stain). Immunohistochemistry (inset) showing major basic protein of eosinophils (immunostaining).QuestionWhat is the most likely diagnosis?Buerger’s diseaseEosinophilic vasculitisDrug abuseCholesterol embolisation syndromeParaneoplastic syndrome

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Eosinophilic Vasculitis: Time for Recognition of a New Entity?

Cited by 10 publications

References 21 publications

Skin-limited idiopathic hypereosinophilic syndrome presenting with retiform purpura

Skin-limited idiopathic hypereosinophilic syndrome presenting with retiform purpura

Hypereosinophilia in a Young Patient: Occam’s Razor or Hickam’s Dictum?

Finger necrosis with eosinophilia and symmetrical occlusion of the peripheral artery

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