eosinophilia
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Introduction
Defined as > 500/mm3 of eosinophils in peripheral blood.
Etiology
- pharmaceuticals are the second most common cause of severe eosinophilia[10]
- 25% of patients on long-term IV antibiotics will develop eosinophilia[6]
- vancomycin may pose greatest risk[6]
- sulfonamides, carbamazepine[4]
- 25% of patients on long-term IV antibiotics will develop eosinophilia[6]
- helminth infection, especially invading tissues (3% of severe eosinophilia):
- Strongyloides (recent travel to endemic areas)
- transient pulmonary infiltrates (patchy pulmonary opacities) suggests Loffler's syndrome
- atopic (generally mild eosinophilia)
- pulmonary disorders (8% of severe eosinophilia): eosinophilic pneumonia
- connective tissue disease
- neoplasms are most common cause of severe eosinophilia (39%)[10]
- eosinophilic leukemia
- adenocarcinoma of the lung
- lymphoma
- chronic myeloid leukemia is the most common neoplasm associated with severe eosinophilia (60%)[10]
- polycythemia vera
- myelofibrosis with myeloid metaplasia
- metastatic cancer, especially with necrosis
- hematologic disorders, non-malignant
- gastrointestinal disorders (7% of severe eosinophilia): eosinophilic gastroenteritis
- skin diseases:
- granulomatous diseases
- sarcoidosis
- tuberculosis:
- eosinophilia is not common, pulmonary infiltrates are not transiet
- coccidioidomycosis
- eosinophilic granulomatosis with polyangiitis[4]
- eosinophil myalgia syndrome
- hypereosinophilia syndrome
- toxic oil syndrome
- smoking
- Addison's disease (low grade eosinophilia)
- immunodeficiency syndromes
- idiopathic (17% of severe eosinophilia)[10]
I: idiopathic hypereosinphilic syndrome
N: neoplasms, most commonly lymphoma, chronic myeloid leukemi
A: allergy, atopy, asthma; also drug-induced[4]
Laboratory
- complete blood count (CBC) -> eosinophilia
- severe eosinophilia is absolute eosinophil count > 5000/uL[10]
- see ARUP consult[9]
Complications
- hypersensitivity reaction[6]
- hypereosinophilic syndrome can result in organ damage[4][10]
- severe eosinophilia can result in organ damage[10]
Management
- treat underlying disorder
- glucocorticoids have a lytic effect on peripheral & tissue eosinophils[4]
More general terms
More specific terms
Additional terms
- acute eosinophilic leukemia
- drugs causing eosinophilia
- eosinophil
- eosinophilia-myalgia syndrome (EMS)
- hypereosinophilic syndrome
- parasites frequently associated with eosinophilia
- pulmonary infiltrates with eosinophilia (PIE) syndrome
References
- ↑ Harrison's Principles of Internal Medicine, 13th ed. Companion Handbook, Isselbacher et al (eds), McGraw-Hill Inc. NY, 1995, pg 829-39
- ↑ Internal Medicine, Stein et al (eds), Little Brown & Co, Boston 1983, pg 1137
- ↑ Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed) Lippincott-Raven, Philadelphia, 1998, pg 32
- ↑ 4.0 4.1 4.2 4.3 4.4 4.5 Medical Knowledge Self Assessment Program (MKSAP) 11, 17, 18, 19. American College of Physicians, Philadelphia 1998, 2015, 2018, 2022.
Medical Knowledge Self Assessment Program (MKSAP) 19 Board Basics. An Enhancement to MKSAP19. American College of Physicians, Philadelphia 2022 - ↑ Clinical Guide to Laboratory Tests, 3rd ed. Teitz ed., W.B. Saunders, 1995
- ↑ 6.0 6.1 6.2 6.3 Blumenthal KG et al. Peripheral blood eosinophilia and hypersensitivity reactions among patients receiving outpatient parenteral antibiotics. J Allergy Clin Immunol 2015 Nov; 136:1288. PMID: https://www.ncbi.nlm.nih.gov/pubmed/25981739
- ↑ Rothenberg ME. Eosinophilia. N Engl J Med. 1998 May 28;338(22):1592-600. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/9603798
- ↑ Roufosse F, Weller PF. Practical approach to the patient with hypereosinophilia. J Allergy Clin Immunol. 2010 Jul;126(1):39-44. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/20538328 Free PMC Article
- ↑ 9.0 9.1 ARUP Consult: Eosinophil-Related Disorders - Eosinophilia The Physician's Guide to Laboratory Test Selection & Interpretation https://www.arupconsult.com/content/eosinophil-associated-diseases
- ↑ 10.0 10.1 10.2 10.3 10.4 10.5 10.6 10.7 Lam BD, Hale AJ, Bullis SM et al. A retrospective review of 193 cases of severe eosinophilia in the northeast United States. Am J Med 2021 Jun; 134:e374. PMID: https://www.ncbi.nlm.nih.gov/pubmed/33359774 https://www.amjmed.com/article/S0002-9343(20)31123-2/fulltext