Practical approach to the patient with hypereosinophilia

Abstract

Markedly increased blood eosinophilia, ≥1.5 × 10 9 /L, whether discovered fortuitously or found with signs and symptoms of associated organ involvement, commands diagnostic evaluation and often therapeutic interventions. This degree of hypereosinophilia is often, but not uniformly, associated with eosinophilic infiltration of tissues that can potentially lead to irreversible, life-threatening organ damage. Initial approaches focus on ascertaining that eosinophilia is not secondary to other underlying disease processes, including helminth parasite infections, varied types of adverse reactions to medications, and other eosinophil-associated syndromes, such as eosinophilic gastroenteritides, eosinophilic pneumonias and Churg-Strauss syndrome vasculitis. If evaluations exclude eosinophilia attributable to secondary etiologies or other eosinophil-related syndromes or organ-specific diseases, attention must be directed to considerations of varied other forms of the hypereosinophilic syndromes, that include myeloproliferative variants, lymphocytic variants and many of still unknown etiologies. Cognizant of the capacities of eosinophils to mediate tissue damage, the varied etiologies for hypereosinophilia are considered and a contemporary step-wise practical approach to the diagnosis and treatment of patients with hypereosinophilia is presented.

Eosinophilia as a presenting symptom of the metastatic lung adenocarcinoma with an unknown primary localization

“…The term hypereosinophilia is used when the eosinophil count exceeds 1.5 × 10 9 /L [3,4]. Non-malignant hematological conditions in which eosinophilia is a common finding are pernicious anemia and post-splenectomy status.…”

“…Malignancy-associated eosinophilia is a well-recognized but unusual symptom in different malignancies, in which the pathogenesis seems to be related to an increased production and secretion of cytokines and growth factors, especially interleukin(IL)-3, IL-5 and granulocyte-macrophage colony-stimulating factor (GM-CSF); either by the malignant cells themselves or by reactive CD4 positive T-helper type 2 lymphocytes [2][3][4]7,8]. Hematological malignancies presenting with eosinophilia include classical myeloproliferative disorders (i.e.…”

“…Underlying conditions that can cause eosinophilia range from allergic reactions, parasitic infections, connective tissue disorders, or adverse drug reactions (e.g., anticonvulsants, sulpha drugs, allopurinol), to malignancies [2,3]. Allergic disorders including drug hypersensitivity reactions are the most common etiology of secondary eosinophilia in industrial countries while parasitic infections are in developing countries.…”

“…Although it is generally advised that malignancy should be taken into consideration in the diagnostic work-up of eosinophilia, some have argued against extensive investigation, their reasoning being that most tumor-associated eosinophilia is accompanied by an advanced and clinically obvious metastatic disease [3,5]. However, in rare instances eosinophilia due to a paraneoplastic process can be the presenting symptom of an as yet unknown primary malignancy [6].…”

En mann i 40-årene med diabetes, forstørret tårekjertel og nyresvikt

“…Eosinofili bør også utredes og kan blant annet ses ved allergier, medikamentreaksjoner, eosinofil pneumoni, eosinofil leukemi, bronkopulmonal aspergillose, eosinofil granulomatose med polyangitt (tidligere kalt ChurgStrauss' syndrom) og parasittsykdommer (9 Nyrebiopsi som ledd i utredning av nyresvikt er forbeholdt tilstander der man antar at svaret vil få konsekvenser for behandlingen. Typiske indikasjoner er nefrittiske eller nefrotiske syndromer, raskt progredierende glomerulonefritt eller vaskulitter, i tillegg til situasjoner hvor man for eksempel mistenker en diabetesnefropati, men proteinurien er uttalt, og/eller retinopati er fravaerende (10).…”