Evaluation and Differential Diagnosis of Marked, Persistent Eosinophilia

Abstract

Synopsis:Hyperosinophilic syndromes (HES) are a group of heterogeneous disorders many of which remain ill-defined. By definition, the HES must be distinguished from other disorders with persistently elevated eosinophilia with a defined cause. Although marked eosinophilia worldwide is most commonly caused by helminth (worm) infections, the diagnostic approach must include noninfectious (non-parasitic) causes of marked eosinophilia as well.

Hypereosinophilia-and-Intraoperative-Complications-under-General-Anesthesia-in-Surgical-Patients-Aged-12-Years-or-More-an-Observation

“…It was observed that 6 out of 7 patients who had AEC > 2000 x 10 9 /l were prescribed medication for deworming (tablet albendazole) for one day and antihistaminic (tablet levocetrizine) for 5 days as per institutional protocol and it was found to be effective in reducing AEC although most of them still remained in marked HE range. Helminthic infections / infestations are the most common cause of marked eosinophilia worldwide [14] . These infections / infestations are more prevalent in developing and poor socioeconomic countries.…”

A Case of Hypereosinophilic Syndrome with Cutaneous Lesions as Presenting Sign

“…Other causes of eosinophilia must be ruled out before a diagnosis of HES can be made. Common causes of secondary elevated blood eosinophilia include helminthic parasite infections, atopic and allergic diseases and adverse drug reactions [4]. Stools examination ruled out parasitic infestation, prescribed drugs were discontinued at debut and no history of allergic or atopic diseases were present.…”

“…Churg-Strauss syndrome (CSS), eosinophilic pneumonias, lymphoid malignancies and solid tumor neoplasia, systemic mastocytosis and primary immunodeficiency diseases, eosinophilic gastrointestinal diseases and non-helminthic infections e.g. scabies, fungi and tuberculosis [4]. Primary skin diseases associated with blood eosinophilia include atopic disease, autoimmune blistering diseases such as bullous pemphigoid, cutaneous T-cell lymphoma, angiolymphoid hyperplasia and Kimura disease, eosinophilic cellulitis, panniculitis and vasculitis, and eosinophilic postural folliculitis [4,5].…”

“…scabies, fungi and tuberculosis [4]. Primary skin diseases associated with blood eosinophilia include atopic disease, autoimmune blistering diseases such as bullous pemphigoid, cutaneous T-cell lymphoma, angiolymphoid hyperplasia and Kimura disease, eosinophilic cellulitis, panniculitis and vasculitis, and eosinophilic postural folliculitis [4,5]. Evidence of these disorders was ruled out by an extensive investigation programme.…”

Clinical Reasoning: A young woman with symmetric weakness and behavioral disturbance

“…Given the unrevealing workup and normal eosinophil count prior to several new medication exposures, this condition was likely drug-induced HES secondary to heroin, fluvoxamine, or amoxicillin, all of which may be associated with drug-induced hypereosinophilia. 8,9 Corticosteroids are the mainstay of HES treatment and should be initiated urgently if life-threatening complications are present. In HES secondary to parasitic infections, steroids should be coadministered with antihelminthic therapy, especially in the setting of Strongyloides infection to prevent potentially fatal dissemination.…”