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eosinophilia

Defined as > 500/mm3 of eosinophils in peripheral blood. Etiology: 1) 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] 2) 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 3) atopic (generally mild eosinophilia) a) allergic rhinitis b) allergic bronchopulmonary aspergillosis (may be marked) c) asthma d) atopic dermatitis e) drug hypersensitivity f) angioneurotic edema 4) pulmonary disorders (8% of severe eosinophilia): eosinophilic pneumonia 5) connective tissue disease a) Churg-Strauss vasculitis b) eosinophilic fasciitis c) polyarteritis nodosa d) rheumatoid arthritis 6) neoplasms are most common cause of severe eosinophilia (39%) [10] a) eosinophilic leukemia b) adenocarcinoma of the lung c) lymphoma d) chronic myeloid leukemia is the most common neoplasm associated with severe eosinophilia (60%) [10] e) polycythemia vera f) myelofibrosis with myeloid metaplasia g) metastatic cancer, especially with necrosis 7) hematologic disorders, non-malignant a) splenectomy b) hypereosinophilic syndrome 8) gastrointestinal disorders (7% of severe eosinophilia): eosinophilic gastroenteritis 9) skin diseases: a) pemphigus b) bullous pemphigoid c) dermatitis herpetiformis d) exfoliative dermatitis e) eczema 10) granulomatous diseases a) sarcoidosis b) tuberculosis: - eosinophilia is not common, pulmonary infiltrates are not transiet c) coccidioidomycosis d) eosinophilic granulomatosis with polyangiitis [4] 11) eosinophil myalgia syndrome 12) hypereosinophilia syndrome 13) toxic oil syndrome 14) smoking 15) Addison's disease (low grade eosinophilia) 16) immunodeficiency syndromes 17) idiopathic (17% of severe eosinophilia) [10] C: Churg-Strauss syndrome H: helminth infection 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]

Related

acute eosinophilic leukemia drugs causing eosinophilia eosinophil eosinophilia-myalgia syndrome (EMS) hypereosinophilic syndrome parasites frequently associated with eosinophilia pulmonary infiltrates with eosinophilia (PIE) syndrome

Specific

pulmonary esosinophilia

General

leukocytosis

References

  1. Harrison's Principles of Internal Medicine, 13th ed. Companion Handbook, Isselbacher et al (eds), McGraw-Hill Inc. NY, 1995, pg 829-39
  2. Internal Medicine, Stein et al (eds), Little Brown & Co, Boston 1983, pg 1137
  3. Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed) Lippincott-Raven, Philadelphia, 1998, pg 32
  4. 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
  5. Clinical Guide to Laboratory Tests, 3rd ed. Teitz ed., W.B. Saunders, 1995
  6. 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: 25981739
  7. Rothenberg ME. Eosinophilia. N Engl J Med. 1998 May 28;338(22):1592-600. Review. PMID: 9603798
  8. Roufosse F, Weller PF. Practical approach to the patient with hypereosinophilia. J Allergy Clin Immunol. 2010 Jul;126(1):39-44. Review. PMID: 20538328 Free PMC Article
  9. ARUP Consult: Eosinophil-Related Disorders - Eosinophilia The Physician's Guide to Laboratory Test Selection & Interpretation https://www.arupconsult.com/content/eosinophil-associated-diseases
  10. 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: 33359774 https://www.amjmed.com/article/S0002-9343(20)31123-2/fulltext