hematology and oncology
Eosinophilia
Etiology of Eosinophilia
Eosinophilia may be Primary: A clonal proliferation of eosinophils associated with hematologic disorders such as Overview of Leukemia and Secondary: Caused by or associated with nonhematologic disorders (see table) Idiopathic: Cause cannot be identified Themost common causeof eosinophilia in the United States is Allergic or atopic disorders (typically respiratory or dermatologic) In cases caused by allergic or atopic disorders, eosinophilia is often mild to moderate ( General references ). Other common causesof eosinophilia include Infections (typically parasitic) Certain tumors (hematologic or solid, benign or malignant) Almost any parasitic invasion of tissues can elicit eosinophilia, but protozoa (amoeba) and noninvasive metazoa usually do not. Of hematologic tumors, Hodgkin Lymphoma may elicit marked eosinophilia, whereas eosinophilia is less common in The pulmonary infiltrates that may occur with peripheral eosinophilia are part of a spectrum of clinical disorders, which can be infectious, autoimmune, or inflammatory in nature. Patients with eosinophilic drug reactions may be asymptomatic or have various syndromes, including Tubulointerstitial Nephritis , Eosinophilia-myalgia syndrome is rare; the cause is unknown. However, in 1989, several hundred patients were reported to have developed this syndrome after taking L-tryptophanfor sedation or psychotropic support. This syndrome was probably caused by a contaminant rather than byL-tryptophan. The symptoms, including severe muscle pain, tenosynovitis, muscle edema, and rash, lasted weeks to months, and several deaths occurred. Drug reaction with eosinophilia and systemic symptoms (DRESS) is a rare syndrome characterized by fever, rash, eosinophilia, atypical lymphocytosis, lymphadenopathy, and signs and symptoms related to end-organ involvement (typically, heart, lungs, spleen, skin, nervous system) ( General references ). Eosinophilic Esophagitis is an increasingly recognized condition characterized by vomiting and dysphagia. To make a diagnosis, esophageal biopsy should show at least 15 eosinophils per high power field. Treatment includes proton pump inhibitors, 1.Klion AD: Approach to the patient with suspected hypereosinophilic syndrome.Hematology Am Soc Hematol Educ Program2022; 2022(1):47-54. doi: 10.1182/hematology.2022000367 2.Wei BM, Fox LP, Kaffenberger BH, et al. Drug-induced Hypersensitivity Syndrome / Drug Reaction with Eosinophilia and Systemic Symptoms. Part I. Epidemiology, Pathogenesis, Clinicopathological Features, and Prognosis [published online ahead of print, 2023 Jul 27].J Am Acad Dermatol2023;S0190-9622(23)02402-7. doi:10.1016/j.jaad.2023.02.072 3.Wei BM, Fox LP, Kaffenberger BH, et al. Drug-induced Hypersensitivity Syndrome / Drug Reaction with Eosinophilia and Systemic Symptoms. Part II. Diagnosis and Management [published online ahead of print, 2023 Jul 27].J Am Acad Dermatol2023;S0190-9622(23)02403-9. doi:10.1016/j.jaad.2023.02.073 4.Muir A, Falk GW: Eosinophilic esophagitis: a review.JAMA326: 1310–1318, 2021. doi: 10.1001/jama.2021.14920 