DOCSLIB.ORG

Pulmonary Involvement of Hypereosinophilic Syndrome : High-Resolution CT Findings in Three Patients1

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Pulmonary Involvement of Hypereosinophilic Syndrome : High-Resolution CT Findings in Three Patients1 Journal ofthe Korean Radiological Society 1996 : 35 (3) : 343 - 345 Pulmonary Involvement of Hypereosinophilic Syndrome : High-Resolution CT Findings in Three Patients1 Eun-Young Kang, M.D., Mee Ran Lee, M.D., Jae Jeong Shim, M.D.2 Hypereosinophilic syndrome is a rare entity of eosinophilic lung disease characterized by idiopathic prolonged eosinophilia of marked degree and vari­ able organ involvement. Pulmonary involvement of hypereosinophilic syndrome occurs in up to 40% of patients. We report HRCT findings of three patients with p 비 monary involvement of hypereosinophilic syndrome diagnosed by clinical manifestation, bronchoalveolar lavage and transbronchiallung biopsy. On H RCT, several small nodules were seen in both lungs, especially in peripherallung areas of the three patients. One had nodules with ground-glass attenuation halo and also focal areas of ground-glass attenuation in this area. Index Words : Lung , diseases Lung , CT Hypereosinophilic syndrome (HES) is an infiltrative ated leukocyte count of 15000 per cubic mm with mar­ disease of eosinophils affecting multiple organs, in­ ked eosinophilia(total eosinophil count, 8880). Focal cluding the lung (1). The criteria for this diagnosis in­ lesions were found in her liver. Ultrasound guided bi­ clude persistent eosinophilia of 1500 eosinophils per opsy of the focallesion revealed eosinophilic abscess. cubic mm for longer than six months or death before six A bone marrow biopsy was performed ; it revealed 42 months, the absence of parasitic, allergic or other know­ % of mature eosinophils and no evidence of leukemia n causes of eosinophilia, and evidence of organ in­ She did not complain any neurologic symptoms or car­ volvement (1 , 2). Pulmonary involvement occurs in 40 diac problems. Chest radiograph was normal , though percent of HES, mainly presenting with cough or dysp­ HRCT showed several small nodules in the subpleural nea (3). Patients with HES and pulmonary infiltrates areas of both lungs(Fig. 1). The eosinophil content of may pose certain diagnostic problems such as infec­ bronchoalveolar lavage fluid was 26 % and transbron­ tion , infarction , congestive heartfailure or HES itselt(1, chiallung biopsy on the right lower lobe lesion showed 3 , 4) . The authors report three HES patients with pul­ focal pneumonic infiltration with eosinophils and fi­ monary involvement in whom high-resol ution CT show­ brous exudate. Steroid treatment was started and the ed small nodules in peripherallung areas. liver lesions and eosinophilia improved within two mon­ ths CAS E R EPO RTS Case2 Case1 A 44-year-old man was admitted for evaluation of a A 51-year-old woman was admitted to hospital be­ cough. His medical history was insignificant. Labora­ cause for six months she had felt discomfort in the right tory studies yielded leukocytosis(16000 per cubic mm) upper quadrant of the abdomen. She had no specific with marked eosinophilia(total eosinophil count, 7136) . medical history. Laboratory studies revealed an elev- A chest radiograph showed no abnormalities of the lun­ gs and heart; HRCT showed several small nodules with a ground-glass attenuation halo in both lungs(Fig. 2a) 'Oepartmento fD iag nostic Radio logy , Col lege of Medicine , Korea Universi ty and peripheral focal areas of ground-glass attenuation 20epartment of lnternal Medicine , College of Me di cine , Korea Un ive rsity in the lower lungs(Fig. 2b). Bronchoalveolar lavage Rece ived March23 , 1996 : Accepted June 18, 1996 Address repr in t reques ts to' Eun-Young Kang , M.D. , Oepartm ent of Radio logy , (BAL) revealed 4 % eosinophilia. Microbiologic cultur­ Korea University Guro Hospi tal , # 80 Guro-dong , Guro-ku , Seou l, Korea , es on BAL fluid for tuberculosis, bacteria and fungi 152-050 TE L. (82-2)818-6786 FAX. (82-2)863-9282 were negative. Focal hepatic lesions were found and 쇄% Journal ofthe Korean Radiological Society 1996 : 35 (3) : 343 - 345 ultrasound-guided liver biopsy showed periportal eos­ study, however still revealed eosinophil ia of 8.6 % inophilic infiltation with bridging hepatic necrosis. Gas­ troscopic biopsy revealed eosinophilic mucosal infil­ Case3 trations in the stomach ; A bone marrow biopsy reveal­ A 58-year-old woman was admitted for the evalu­ ed 39.5 % of matured eosinophils. Ster 이 d and busulfan ation of generalized myalgia. Laboratory study reveal­ treatment was started and ten months later the patient ed eosinophilia(total count, 4100). Bone marrow biospy was doing well while receiving therapy; laboratory revealed 16 % of eosinophils ; a chest radiograph show­ ed no abnormalities but HRCT showed several small nodules in both lungs(Fig. 3). Bronchoalveolar lavage revealed 18 % of eosinophils. Despite steroid and hydroxyurea treatment peripheral eosinophilia persis­ ted. Eighteen months later, laboratory study still reveal­ ed eosinophil ia of 21.6 % DISCUSSION The eosinophilic lung diseases are a diverse group of P 비 monary disorders linked by common findings of an increase in circulating or tissue eosinophils Although numerous classifications of these disorders have been proposed , there is no optimal way to classify these disorders (5). Hypereosinophilic syndrome is one characteristic entity of eosinophilic lung diseases and must be differentiated from all other causes of per­ ipheral eosinophilia. The term “ hypereosinophilic syndrome" was first proposed by Hardy and Anderson (6) in 1968. They de­ scribed three patients characterized by severe hyper­ eosinophilia, cardiac or pulmonary symptoms, hepatos- Fig ‘ 1.HRCTshowstwosmallnodules(arrows)inthesubpleural plenomegaly, constitutional symptoms, anemia, and area 01 right lower lobe. diffuse organ infi Itration by matu re eosi noph ils. Hyper 2a 2b 3 Fig. 2. a. HRCT shows two small nodules with ground-glass attenuation halo (arrows) in left upper lobe and one in I eft lower lobe b. HRCT shows.local areas 01 ground-glass attenuation (arrows) in peripheral area 01 left lower lobe Fig. 3. HRCT shows small nodules (arrows) in peripheral areas 01 right middle and lower lobes t ‘ …않 Eun -Youn g Ka ng, etal : Pul mona ry lnvolvementof Hypereos in ophilic Syndrome eosinophilic syndrome represents a heterogeneous fluid was elevated in all three patients, and TBLB that group of disorders characterized by a idiopathic pro­ was performed i~ 0ne pattent showed focal pneumonic longed eosinophilia of marked degree and, further­ infiltrations with eosinophils. These results strongly more, by variable organ dysfunction. It may involve vir­ suggest HES-related pulmon'ary involvement. Other or­ tually any organ system , though bone marrow hyper­ gan systems involved in our patients included the stom­ eosinophilia is common to all patients. The most sev­ ach, liver and bone marrow. Early recognition of the ere clinicopathologic involvement is of the heart and syndrome is important becäuse there is strong evi­ nervous system (4). dence that prognosis may.be much improved if treat­ Pulmonary involvement in HES occurs in up to 40 % ment is instituted promptly (9) . of patients, who typically present with cough or dysp­ nea (3 , 5). In patients with HES and pulmonary infiltrat­ REFERENCES es, the condition may be attributed to infecton , infarc­ tion , congestive heart failure or HES-related pulmon­ 1. Winn RE , Kollel MH , Meyer JI. Pulmonary in volve ment in the ary involvement (1 -4). One half of these patients have hypereosi noph ili c syndrome. Chest 1994 ; 105 : 656-660 significant pleural effusion, probably due to congestive 2. Chusid MJ , Dale DC , West BC , Wolff SM . Th e hype r eos inop 에 lic heart fail ure or embol ic phenomena (1 -3). A chest rad syn drome: analysis 01 lourteen cases with review 01 the litera­ iograph shows focal or diffuse, interstitial or alveolar, ture. Medicine 1975 ; 54 : 1-27 and nonlobar infiltrates (1 -3, 5-8). Winn et al (1) rep­ 3. Slabbynck h, Impens N‘ Naegels S, Dewaele M; Schandevyl W orted a patient who presented with ARDS that was Idi opathic hypereosinophili c synd ro me-related pulmonary in­ thought to be a complication of HES. Hilar Iymphad­ volvement diagnosed by bro nchoal veolar lavage. Chest 1992 ; enopathy was noted, but the prevalence of intrathor­ 101 :1178-1180 acic Iymphadenopathy had not been assessed. Histop­ 4. Fauci AS , Har ley JB , Rob ers WC , Ferrans VJ, Gralnick'HR , Bj or­ athology demonstrates striking infiltration of involved nson BH. The idiopathic hypereosinophilic syndrome. Clinical , pathoph ys iologic , and therapeutic considerati ons ..Ann Inter Med organs by eosinophils, is associated with disruption of 1982 ; 97 : 78-92 the architecture, and there are areas of necrosis. BAL 5. Allen JN, Davis WB. Eosin ophilic lung disease. Am J Respir Crit fluid eosinophilia may suggest HES-related p 비 monary Care Med 1994; 150 : 1423-1438 involvem ent (3 , 5). 6. Hardy WR, Anderson RE. The hypereosinophili c synd rome. Ann To our knowledge, this is the first report of HRCT fin­ Int Med 1968 ; 68 : 1220-1229 dings in patients with lung involvement of HES. In spite 7. Shannon JJ , Lynch JP. Eosinophi li c pulmonary syndromes. Clin ofno specfific abnormalities on chest radiographs, sev­ Pulm Med 1995 ; 2: 19-38 eral small nodules were seen in both lungs, especially 8. Epstein DM , Taormina V, Gefter WB , Mi ll er WT. The hyperesos­ peripheral lung areas on HRCT. One of them showed in ophil ic syndrome. Radiology 1981 ; 140 : 59-62 focal areas of ground-glass attenuation located sub­ 9. Fraser RG , Pare JAP. Diagnosis of diseases ofthe chest. 3rd ed pleurally and ground-glass attenuation halo around Ph iladelph ia: Saunders , 1989 : 1298-1299 nodules. In our patients, the eosinophil count in BAL 대 한 방 사 선 의 학 회 지 1996 ; 35( 3) : 343 -345 과호산구증후군의 폐침범 : 3 예의 고해상전산화단층촬영 소견 1 1 고려대학교의과대학진단방사선과학교실 2 고려대학교의과대학 내과학교실 강은영·이미란 · 심재정 2 과호산구증후군은여러장기를침범하는 드문 특발성호산구성폐질환의하 나로써 그중폐침범 은 40 %에서보고되 고 있 다.저 자들은임상적으로 그리고 기관지 폐포세척액과 기관지내시겸하 패생검으로진단된 3예의 특발성 과호산구증후군의 폐 침범의 고해상전산화 단층촬영 소견 을보고하고자 한다 .3예 모두에서 수개의 작은결절들이 앙폐야특히 주 변부 폐야에 분포되었고，그 중 1 여 | 에서는결절주위의 간유리음영의 환과국소간유 리 음영을보였 다.
Load more

Recommended publications
  • Hypersensitivity Reactions (Types I, II, III, IV)
    Hypersensitivity Reactions (Types I, II, III, IV) April 15, 2009 Inflammatory response - local, eliminates antigen without extensively damaging the host’s tissue. Hypersensitivity - immune & inflammatory responses that are harmful to the host (von Pirquet, 1906) - Type I Produce effector molecules Capable of ingesting foreign Particles Association with parasite infection Modified from Abbas, Lichtman & Pillai, Table 19-1 Type I hypersensitivity response IgE VH V L Cε1 CL Binds to mast cell Normal serum level = 0.0003 mg/ml Binds Fc region of IgE Link Intracellular signal trans. Initiation of degranulation Larche et al. Nat. Rev. Immunol 6:761-771, 2006 Abbas, Lichtman & Pillai,19-8 Factors in the development of allergic diseases • Geographical distribution • Environmental factors - climate, air pollution, socioeconomic status • Genetic risk factors • “Hygiene hypothesis” – Older siblings, day care – Exposure to certain foods, farm animals – Exposure to antibiotics during infancy • Cytokine milieu Adapted from Bach, JF. N Engl J Med 347:911, 2002. Upham & Holt. Curr Opin Allergy Clin Immunol 5:167, 2005 Also: Papadopoulos and Kalobatsou. Curr Op Allergy Clin Immunol 7:91-95, 2007 IgE-mediated diseases in humans • Systemic (anaphylactic shock) •Asthma – Classification by immunopathological phenotype can be used to determine management strategies • Hay fever (allergic rhinitis) • Allergic conjunctivitis • Skin reactions • Food allergies Diseases in Humans (I) • Systemic anaphylaxis - potentially fatal - due to food ingestion (eggs, shellfish,
    [Show full text]
  • Bronchopulmonary Aspergillosis
    Thorax: first published as 10.1136/thx.44.11.919 on 1 November 1989. Downloaded from Thorax 1989;44:919-924 Pulmonary eosinophilia with and without allergic bronchopulmonary aspergillosis B J CHAPMAN, S CAPEWELL, R GIBSON, A P GREENING, G K CROMPTON From the Respiratory Unit, Northern General Hospital, Edinburgh ABSTRACT Sixty five patients with pulmonary eosinophilia attending one respiratory unit were reviewed. All had fleeting radiographic abnormalities and peripheral blood eosinophil counts greater than 500 x 106/1. Eighteen had a single episode and 47 recurrent episodes during a median follow up period of 14 years. Thirty three patients had allergic bronchopulmonary aspergillosis on the basis of a positive skin test response to Aspergillusfumigatus, serum precipitins, or culture ofAfumigatus from sputum, or a combination of these. All but seven patients had asthma, six of the seven being in the group who did not have allergic bronchopulmonary aspergillosis. The patients with allergic bronchopulmonary aspergillosis were more often male and had a greater incidence ofasthma and an earlier age of onset of asthma than those without aspergillosis. The patients with aspergillosis had lower mean blood eosinophil counts and more episodes of pulmonary eosinophilia and more commonly had radiographic shadowing that suggested fibrosis or bronchiectasis (20 v 7). Pulmonary eosinophilia associated with allergic bronchopulmonary aspergillosis appears to be a distinct clinical syndrome resulting in greater permanent radiographic abnormality despite lower peripheral blood eosinophil counts. copyright. Introduction ated from secondary and tertiary referral centres, which makes it difficult to estimate the relative The term pulmonary eosinophilia describes a group of frequency of the various underlying conditions.
    [Show full text]
  • The Role of Eosinophils in Parasitic Helminth Infections: Insights from Genetically Modified Mice C.A
    Reviews The Role of Eosinophils in Parasitic Helminth Infections: Insights from Genetically Modified Mice C.A. Behm and K.S. Ovington Eosinophilia – an increase in the number of eosinophils in the it has been shown that IL-5, found at high levels in blood or tissues – has historically been recognized as a dis- helminth-infected hosts during the T-helper type 2 tinctive feature of helminth infections in mammals. Yet the (Th2) cytokine-biased immune response, appears to be precise functions of these cells are still poorly understood. important in mucosal immune responses and is re- Many scientists consider that their primary function is pro- sponsible for helminth-induced eosinophilia. IL-5 pre- tection against parasites, although there is little unequivocal sents quite a puzzle for immunologists. It has been in vivo evidence to prove this. Eosinophils are also respon- highly conserved during mammalian evolution – sible for considerable pathology in mammals because they are mouse IL-5, for example, has 71% amino acid identity inevitably present in large numbers in inflammatory lesions with human IL-5 – which suggests it has important associated with helminth infections or allergic conditions. In function(s) that have been selected during evolution. this review, Carolyn Behm and Karen Ovington outline some However, functions exclusive to IL-5 are not numer- of the cellular and biological properties of eosinophils and ous, and none appears to be essential for survival, at evaluate the evidence for their role(s) in parasitic infections. least for mice living in laboratory conditions. In mice, IL-5 controls or influences the development of two Eosinophils or ‘eosinophilic granulocytes’ normally major cell types: the elevated rate of development, mat- comprise only a small fraction (,1–5%) of circulating uration and survival of eosinophils during a Th2 cyto- leukocytes.
    [Show full text]
  • Hypereosinophilic Syndrome Presenting As an Unusual Triad of Eosinophilia, Severe Thrombocytopenia, and Diffuse Arterial Thromboses, with Good Response to Mepolizumab
    H & 0 C l i n i C a l C a s e s t u d i e s Hypereosinophilic Syndrome Presenting As an Unusual Triad of Eosinophilia, Severe Thrombocytopenia, and Diffuse Arterial Thromboses, With Good Response to Mepolizumab 1Department of Internal Medicine, University of Iowa 1 Roberto A. Leon-Ferre, MD Hospitals and Clinics, Iowa City, Iowa; 2Division of 2 Catherine R. Weiler, MD, PhD Allergic Diseases and Internal Medicine, Mayo Clinic, Thorvardur R. Halfdanarson, MD3 Rochester, Minnesota; 3Division of Hematology and Medical Oncology, Mayo Clinic Arizona, Scottsdale, Arizona Case Report Complement studies were normal. Fluorescence in situ hybridization (FISH) screening for FIP1L1-PDGFRA A previously healthy 47-year-old man presented with rearrangement was negative. A bone marrow biopsy 3 weeks of bilateral hand numbness, tingling, cyanosis, revealed a normocellular marrow, with marked eosino- and newly onset lower extremity edema and petechiae. philia (47%), adequate numbers of megakaryocytes, and On examination, both hands were dusky, cold, and exqui- no increase in blasts, mast cells, or reticulin fibrosis. Cyto- sitely tender. Bilateral radial pulses and left popliteal pulse genetic studies showed no abnormalities. Peripheral blood were not palpable. No lymphadenopathy, organomegaly, flow cytometry did not identify monoclonal cell popula- or masses were detected. Initial workup revealed severe tions, and no underlying T-cell clone was detected using a eosinophilia and thrombocytopenia (white blood cell T-cell receptor gene rearrangement polymerase chain reac- count, 20.3 × 103/μL; eosinophil count, 10.9 × 103/μL; tion (PCR) study. Serum protein electrophoresis, serum platelet count, 8 × 103/μL), and normal hemoglobin immunofixation electrophoresis, and urine immunofixa- of 15.2 g/dL.
    [Show full text]
  • Eosinophilic Myocarditis Presenting with Hypoactive Delirium and Cardioembolic Stroke
    PRACTICE | CASES CPD Eosinophilic myocarditis presenting with hypoactive delirium and cardioembolic stroke Ka Hong Chan MD, Paul Gibson MD n Cite as: CMAJ 2019 October 21;191:E1159-63. doi: 10.1503/cmaj.190669 64-year-old woman with normal baseline functioning presented to hospital with an altered level of conscious- KEY POINTS ness. She had a history of hypertension (perindopril Hypereosinophilic syndrome is a rare condition manifested by 8 mg/d),A gout (allopurinol 200 mg/d) and anxiety (sertraline • hypereosinophilia with ensuing end-organ damage secondary 100 mg/d). She was brought to the hospital by her husband to tissue infiltration and inflammation by these cells; cardiac because of a 3-day history of being in a hypoactive state with uri- involvement from hypereosinophilic syndrome is known as nary and stool incontinence. Her husband reported no preceding eosinophilic myocarditis. infectious, allergic or constitutional symptoms. Family history • The pathophysiology of eosinophilic myocarditis is characterized and rheumatologic review of systems were noncontributory, and by 3 phases: acute necrosis (asymptomatic), thrombosis the patient had no recent history of rashes. There had been no (presents with secondary embolic phenomenon) and fibrosis (most common presentation; presents with cardiomyopathy). out-of-country travel in the preceding 2 years. Treatment of eosinophilic myocarditis relies on elucidating the On admission, the patient’s temperature was 36.3°C, she had a • underlying cause of eosinophilia, which can be broadly regular heart rate of 103 beats/min, her blood pressure was categorized as idiopathic, hypersensitivity, rheumatologic, 128/78 mm Hg and oxygen saturation was 95% on room air.
    [Show full text]
  • Original Article Anemia, Leukocytosis and Eosinophilia in a Resource-Poor
    Original Article Anemia, leukocytosis and eosinophilia in a resource-poor population with helmintho-ectoparasitic coinfection Daniel Pilger1, Jörg Heukelbach2, Alexander Diederichs1, Beate Schlosser1, Cinthya Pereira Leite Costa Araújo3, Anne Keysersa1, Oliver Liesenfeld1, Hermann Feldmeier1 1Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Institute of Microbiology and Hygiene, D-12203 Berlin, Germany 2Department of Community Health, School of Medicine, Federal University of Ceará, Fortaleza, CE 60430-140, Brazil 3Department of Hematology, Estate University of Health Science of Alagoas, Alagoas, CEP 57010-300, Brazil Abstract Introduction: Eosinophilia and anemia are very common hematological alterations in the tropics but population-based studies scrutinizing their value for diagnosing parasitic infections are rare. Methodology: A cross-sectional study was conducted in a rural district in northeast Brazil where parasitic infections are common. Stool and blood samples were collected and individuals were clinically examined for the presence of ectoparasites. Results: In total, 874 individuals were examined. Infection with intestinal helminths occurred in 70% (95% CI 67 – 75), infestation with ectoparasites in 45% (95% CI 42 - 49) and co-infection with both helminths and ectoparasites was found in 33% (95% CI 29% - 36%) of all inhabitants. Eosinophil counts ranged from 40/µl to 13.800/µl (median: 900/µl). Haemoglobin levels ranged from 4.8 g/dl to 16.8 g/dl (median: 12.5 g/dl), and anemia was present in 24% of the participants. Leukocytosis was found in 13%, eosinophilia in 74%, and hypereosinophilia in 44% of the participants. Eosinophilia was more pronounced in individuals co-infected with intestinal helminths and ectoparasites (p < 0.001) and correctly predicted parasitic infection in 87% (95% CI 84%-90.7%) of all cases.
    [Show full text]
  • I M M U N O L O G Y Core Notes
    II MM MM UU NN OO LL OO GG YY CCOORREE NNOOTTEESS MEDICAL IMMUNOLOGY 544 FALL 2011 Dr. George A. Gutman SCHOOL OF MEDICINE UNIVERSITY OF CALIFORNIA, IRVINE (Copyright) 2011 Regents of the University of California TABLE OF CONTENTS CHAPTER 1 INTRODUCTION...................................................................................... 3 CHAPTER 2 ANTIGEN/ANTIBODY INTERACTIONS ..............................................9 CHAPTER 3 ANTIBODY STRUCTURE I..................................................................17 CHAPTER 4 ANTIBODY STRUCTURE II.................................................................23 CHAPTER 5 COMPLEMENT...................................................................................... 33 CHAPTER 6 ANTIBODY GENETICS, ISOTYPES, ALLOTYPES, IDIOTYPES.....45 CHAPTER 7 CELLULAR BASIS OF ANTIBODY DIVERSITY: CLONAL SELECTION..................................................................53 CHAPTER 8 GENETIC BASIS OF ANTIBODY DIVERSITY...................................61 CHAPTER 9 IMMUNOGLOBULIN BIOSYNTHESIS ...............................................69 CHAPTER 10 BLOOD GROUPS: ABO AND Rh .........................................................77 CHAPTER 11 CELL-MEDIATED IMMUNITY AND MHC ........................................83 CHAPTER 12 CELL INTERACTIONS IN CELL MEDIATED IMMUNITY ..............91 CHAPTER 13 T-CELL/B-CELL COOPERATION IN HUMORAL IMMUNITY......105 CHAPTER 14 CELL SURFACE MARKERS OF T-CELLS, B-CELLS AND MACROPHAGES...............................................................111
    [Show full text]
  • Persistent Eosinophilia Is a Challenging Problem
    DOI: 10.26717/BJSTR.2017.01.000244 Nahla A M Hamed. Biomed J Sci & Tech Res ISSN: 2574-1241 Editorial Open Access Persistent Eosinophilia is a Challenging Problem Nahla AM Hamed* Professor of Hematology, Faculty of Medicine, Alexandria University, Egypt Received: July 25, 2017; Published: August 01, 2017 *Corresponding author: Nahla AM Hamed, Professor of Hematology, Faculty of Medicine, Alexandria University, Egypt Abstract 9 HE is defined as >1.5 x 10 /L eosinophils in the blood on 2 examinations (interval >1 mo) and/or tissue HE defined by: eosinophils percentage in BM section exceeding 20% of all nucleated cells; and/or extensive eosinophilic tissue infiltration by pathologist opinion; and/or presenceAbbreviations: of marked deposition of eosinophil granule proteins (in the absence or presence of major tissue eosinophils infiltration). AEC: absolute eosinophil count; HE: Hypereosinophilia; ABPA: Allergic Bronchopulmonary Aspergillosis; B-ALL: Acute B-cell lymphoblastic leukemia; GVHD: Graft-Versus-Host Disease; BM: Bone Marrow; PB: Peripheral Blood; IL5: Interleukin 5; AML: Acute Myeloid Leukemia; LV: Lymphocytic Variant; Th2:T-cells have a helper type 2; EPPER: Eosinophilic, polymorphic, and pruritic Eruption Associated with Radiotherapy; MPN: Myeloproliferative Neoplasm; HES: Hypereosinophilic Syndrome; PDGFRA: Platelet-Derived Growth Factor Receptor Alpha; PDGFRB: Platelet-Derived Growth Factor Receptor Beta; FGFR1: Fibroblast Growth Factor Receptor 1; CEL-NOS: Chronic Eosinophilic Leukemia-Not Otherwise Specified; MDS: Myelodysplastic Syndrome; IgH: Ig Heavy Chain; EBV: Epstein-Barr virus Introduction cystic structures (e.g. hydatid cyst, neurocysticercosis) are unlikely Eosinophilia3 is defined as an AEC >500/μL [1].3 The severity ), and severe to cause eosinophilia [7]. Disseminated coccidioidomycosis and of eosinophilia has3 been arbitrarily divided into mild9 (AEC: 500- aspergillosis (when presenting as ABPA) are well-known fungal 1,500/mm ), moderate (AEC: 1,500-5,000/mm causes of eosinophilia.
    [Show full text]
  • Anti-IL5 and Anti-Il5rα Therapy for Clinically Significant Bronchiectasis with Eosinophilic Endotype: a Case Series
    AGORA | RESEARCH LETTER Anti-IL5 and anti-IL5Rα therapy for clinically significant bronchiectasis with eosinophilic endotype: a case series To the Editor: Bronchiectasis is a chronic and often progressive disease, which frequently is associated with significant symptom burden, requiring intensive treatment. Regardless of the multiple potential underlying aetiologies, the vicious cycle of airway inflammation, structural airway damage, impaired mucus clearance and airway pathogen acquisition is the crucial pathogenic pathway for the progression of disease [1]. Although inflammation in bronchiectasis has been classically regarded as neutrophilic, it is increasingly recognised that eosinophils may play a role in the disease. Allergic bronchopulmonary aspergillosis (ABPA) is an example of a common cause of bronchiectasis that is primarily eosinophilic. Small studies suggest that a significant number of patients have airway eosinophilia even after exclusion of patients with underlying ABPA and asthma. TSIKRIKA et al. [2] found that among 40 patients with bronchiectasis excluding asthma and ABPA, 30% in total had sputum eosinophilia, defined as >3% cells. This supports the possibility that there may be an eosinophilic endotype of bronchiectasis, although published data on the prevalence and clinical significance of airway and systemic eosinophilia in bronchiectasis remain limited [2, 3]. Mepolizumab, a humanised monoclonal antibody, reduces eosinophil counts in blood and tissues by blocking interleukin (IL)-5, a key eosinophil cytokine, and preventing its binding to eosinophil surface receptors [4]. In patients with severe eosinophilic asthma, add-on mepolizumab treatment resulted in a decrease of exacerbation frequency, reduced symptom burden, improved of quality of life (QoL) and, moreover, had an oral corticosteroid (OCS)-sparing effect [4–8].
    [Show full text]
  • Peripheral Eosinophilia As an Indicator of Meningitic Angiostrongyliasis in Exposed Individuals
    942 Mem Inst Oswaldo Cruz, Rio de Janeiro, Vol. 105(7): 942-944, November 2010 Peripheral eosinophilia as an indicator of meningitic angiostrongyliasis in exposed individuals Kittisak Sawanyawisuth1,4/+, Kanlayanee Sawanyawisuth2, Vichai Senthong1, Panita Limpawattana1, Pewpan M Intapan3,4, Somsak Tiamkao1, Suthipun Jitpimolmard1, Verajit Chotmongkol1,4, Elizabeth Barrett-Connor5 1Department of Medicine 2Department of Biochemistry 3Department of Parasitology, Faculty of Medicine 4The Research and Diagnostic Centre for Emerging Infectious Disease, Khon Kaen University, 123 Mitraparp Friendship Rd., 40002 Khon Kaen, Thailand 5Department of Family and Preventive Medicine, School of Medicine, University of California, La Jolla, San Diego, CA, USA The diagnosis of meningitic angiostrongyliasis (MA) is based on clinical criteria. A lumbar puncture is used as a diagnostic tool, but it is an invasive procedure. The blood eosinophil levels are also assessed and used in the diag- nosis of this disease. We enrolled 47 patients with serologically proven MA and 131 controls with intestinal parasite infections. An absolute eosinophil count model was found to be the best marker for MA. An eosinophil count of more than 798 cells led to sensitivity, specificity, positive predictive and negative predictive values of 76.6%, 80.2%, 58.1% and 90.5%, respectively. These data support the use of testing for high blood eosinophil levels as a diagnostic tool for MA in individuals that are at risk for this disease. Key words: eosinophilia - diagnosis - meningitis - angiostrongyliasis - Angiostrongylus cantonensis Angiostrongylus cantonensis is the main pathogen evaluate the utility of blood eosinophils as a diagnostic that causes eosinophilic meningitis in humans (Chot- tool for meningitic angiostrongyliasis.
    [Show full text]
  • Clinical Relevance of Peripheral Blood Eosinophil Count in Allergic Bronchopulmonary Aspergillosis
    Journal of Infection and Public Health (2011) 4, 235—243 View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by Elsevier - Publisher Connector Clinical relevance of peripheral blood eosinophil count in allergic bronchopulmonary aspergillosis Ritesh Agarwal a,∗, Ajmal Khan a, Ashutosh N. Aggarwal a, Neelam Varma b, Mandeep Garg d, Biman Saikia c, Dheeraj Gupta a, Arunaloke Chakrabarti e a Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Sector-12, Chandigarh 160012, India b Department of Hematology, Postgraduate Institute of Medical Education and Research, Chandigarh, India c Department of Immunopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India d Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India e Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India Received 21 February 2011; received in revised form 17 August 2011; accepted 21 August 2011 KEYWORDS Summary Allergic Background and aims: Currently, there is not a uniform consensus regarding the bronchopulmonary number of criteria or specific cut-off values for the variety of tests that are used to aspergillosis (ABPA); diagnose allergic bronchopulmonary aspergillosis (ABPA). Traditionally, an eosinophil ␮ Aspergillus fumigatus; count >1000 cells/ l is considered an important criterion in the diagnosis of ABPA. Eosinophils The goal of this study was to delineate the significance of the peripheral blood eosinophil count in the diagnosis of ABPA, and the relationship between eosinophil counts and lung function and immunological and radiological parameters. Methods: This study was a retrospective analysis of the data from ABPA patients who were managed in our chest clinic.
    [Show full text]
  • Eosinophilic Lung Diseases: Findings That a Radiologist Should Know
    Pictorial Essay Eosinophilic Lung Diseases: Findings that a Radiologist Should Know Juliana Couture1 Daniel Adri1 Juan Manuel Villegas1 Natalia Posadas1 Alberto Seehaus1 1 Imaging Diagnosis Department, Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina Abstract Eosinophilic lung diseases include a broad spectrum of disorders. The final diagnosis of these diseases is made by patho- logical examination. However, medical history, physical examination and imaging studies allow better characterization of the condition. At present, high-resolution multislice computed tomography (MSCT) is the most sensitive and specific imaging method, since it allows an accurate assessment of diffuse pulmonary pathology, thus avoiding more invasive methods, providing detailed information and depicting lesions that have no specific clinical presentation by means of characteristic imaging patterns. Keywords Hypereosinophilic syndrome, Multislice computed tomography, Pulmonary eosinophilia Introduction depicts lesions that have no specific clinical presentation.7 The most characteristic MSCT findings of eosinophilic syn- Eosinophilic lung diseases are infectious and non-infectious dromes will be discussed below (Table 1). disorders associated with peripheral eosinophilia (a marker of pathology, exceeding 0.5 × 109/L)1,2 with tissue eosino- philia confirmed by pulmonary biopsy or an elevated eosino- Idiopathic eosinophilic lung diseases philic count (25%) in bronchoalveolar lavage (BAL) 3-5. These diseases may be classified as: idiopathic
    [Show full text]