Pulmonary Eosinophilia
Philip T. Cagle, Timothy C. Allen, Mary Beth Beasley in Diagnostic Pulmonary Pathology, 2008
Hypereosinophilic syndrome is an extremely rare disorder characterized by persistent marked eosinophilia in the peripheral blood (>1500 eosinophils/mm3), no known causes for eosinophilia, and signs of multiple organ involvement. Patients commonly present with weakness and fatigue, cough, dyspnea, myalgia or angioedema, rash, fever, or rhinitis. Pulmonary involvement is common, occurring in up to 40% of patients (150–152). Highresolution CT findings in pulmonary involvement consist of patchy areas of consolidaton or nodules variably accompanied by pleural effusion (25). Pulmonary pathologic findings are not well documented. Interstitial infiltrates of eosinophils have been described (151). An isolated report describes eosinophilic infiltration and cuffing of small pulmonary arteries (153). Likewise there is a case report of a patient with pulmonary parenchymal necrosis and infarction (154) as well as another case with features similar to Churg-Strauss syndrome (151).
Mucosal basophils, eosinophils, and mast cells
Phillip D. Smith, Richard S. Blumberg, Thomas T. MacDonald in Principles of Mucosal Immunology, 2020
Finally, hypereosinophilic syndrome comprises a heterogeneous group of disorders characterized by excessive numbers of circulating and tissue-infiltrating eosinophils resulting in organ dysfunction. Some hypereosinophilic syndrome subtypes are myeloproliferative disorders, whereas the etiology of other variants remains undefined. Involvement of the gastrointestinal tract is common, and about 20% of patients experience diarrhea. Hypereosinophilic syndrome is a well-recognized cause of eosinophilic gastritis, gastroenteritis, and colitis, but in contrast to the other primary EGIDs, eosinophilic infiltration of other organs including the heart, skin, and nerves is characteristic. Consequently, hypereosinophilic syndrome might be considered to be a secondary EGID.
Respiratory Disease
John S. Axford, Chris A. O'Callaghan in Medicine for Finals and Beyond, 2023
This is a very rare eosinophilic infiltration of many organs associated with arteritis. It usually presents with pyrexia, weight loss, abdominal pain and congestive cardiac failure resulting from myocardial involvement. Systemic corticosteroids shorten the duration of pulmonary eosinophilia and clear the pulmonary infiltrates. Hypereosinophilic syndrome is treated with oral corticosteroids and anti-IL-5 monoclonal antibodies.
Clinical analysis of hypereosinophilic syndrome first presenting with asthma-like symptoms
Published in Annals of Medicine, 2022
Xuan Wei, Xiaofeng Li, Zuyou Wei, Hui Zhang, Jiehua Deng, Suke Xing, Jianquan Zhang
Hypereosinophilic syndrome (HES) is characterised by persistently elevated levels of eosinophils (EOS), their infiltration into various tissues and organs, and the emergence of corresponding clinical symptoms and signs; the clinical manifestations are complex and diverse. In 2011, the Working Conference on Eosinophil Disorders and Syndromes referred to any hypereosinophilia associated with organ damage as HES, clearly defining idiopathic hypereosinophilic syndrome (HESUS), primary hypereosinophilic syndrome (HESN), secondary hypereosinophilic syndrome (HESR), and other conditions and syndromes [1]. Because HESUS is diagnosed by exclusion, it is difficult to rapidly and effectively diagnose in a clinical setting. One of the most common causes of HESR is parasite infection, which is often ignored and may lead to multiple organ failure [2,3].
Eosinophilic pancreatitis presenting as possible malignancy
Published in Baylor University Medical Center Proceedings, 2021
Rebekah John, Theresa Yanchak, Jonathan Ramirez
EP is an allergic form of chronic pancreatitis that is difficult to distinguish from a pancreatic malignancy.3 EP is characterized by localized or diffuse eosinophilic infiltration of the pancreas and elevated serum IgE levels.3 Classically, diagnosis of EP is based on the presence of eosinophilic infiltration in tissue samples and meeting either hypereosinophilic syndrome or eosinophilic gastritis criteria. Diagnostic criteria for hypereosinophilic syndrome include a peripheral eosinophil count >1.5 × 109 for 6 months; a past medical history of rhinitis, asthma, or other allergic disease; eosinophilic infiltration of other organs; and exclusion of other causes for eosinophilia such as parasitic infestations or leukemia.4 Eosinophilic gastritis is diagnosed by the presence of abdominal pain, vomiting, nausea, diarrhea, or loss of appetite; intestinal sampling showing eosinophilic infiltration and ruling out parasitic infection; and no involvement of organs outside the gastrointestinal tract.
A case of Loeffler’s endocarditis after initiation of adalimumab
Published in Journal of Community Hospital Internal Medicine Perspectives, 2019
Nooreen Hussain, Preeti Patel, Jonathan Yin, Rachael Davis, Ossama Ikladios
Hypereosinophilic syndrome (HES) is a rare blood disorder with the dysregulation and overproduction of eosinophils that ultimately leads to end-organ damage. The systemic response of HES includes skin, pulmonary, gastrointestinal, hematologic, and cardiac involvement and infiltration[1]. Cardiac involvement in HES, also known as Loeffler’s endocarditis, is of utmost concern as it is the most common cause of morbidity and mortality in these patients [2]. Loeffler’s endocarditis is characterized by eosinophilic infiltration of the endo-myocardium (Figure 1), leading to fibrosis and restrictive cardiomyopathy (Figure 2). HES is reported to be a result of adverse drug reactions, parasitic infections, connective tissue diseases, lymphomas, and certain solid tumors [3]. We present a case of Loeffler’s endocarditis in a patient recently started on tumor necrosis factor (TNF) antagonist therapy.
Related Knowledge Centers
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- Eosinophilia
- Autoimmune Disease
- Heart
- Clonal Hypereosinophilia
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- Mepolizumab