Peripheral Eosinophilia

Etiology

Infection

Viral

  • Human Immunodeficiency Virus (HIV) (see Human Immunodeficiency Virus, [[Human Immunodeficiency Virus]])
    • Epidemiology: peripheral eosinophilia in the setting of HIV is usually due to an associated drug, adrenal insufficiency, eosinophilic folliculitis, or other condition rather than due to the HIV itself
  • Human T-Lymphotropic Virus-I (HTLV-I) (see Human T-Lymphotropic Virus Type I, [[Human T-Lymphotropic Virus Type I]])
  • Human T-Lymphotropic Virus-II (HTLV-II) (see Human T-Lymphotropic Virus Type II, [[Human T-Lymphotropic Virus Type II]])

Bacteria

  • Brucellosis (see Brucellosis, [[Brucellosis]])
    • Epidemiology: case reports [Eosinophilia and pneumonitis in chronic brucellosis: a report of two cases. Ann Intern Med. 1942;16:995-1001]
  • Mycobacterium Simiae (see Mycobacterium Simiae, [[Mycobacterium Simiae]])
    • Epidemiology: [Acute eosinophilic pneumonia as a reversible cause of noninfectious respiratory failure. N Engl J Med. 1989;321:569- 574]
  • Tuberculosis (see Tuberculosis, [[Tuberculosis]])
    • Epidemiology: unclear association with peripheral eosinophilia

Fungal

  • Allergic Bronchopulmonary Aspergillosis (ABPA) (see Allergic Bronchopulmonary Aspergillosis, [[Allergic Bronchopulmonary Aspergillosis]])
  • Allergic Bronchopulmonary Candidiasis (see Candida, [[Candida]])
  • Basidiobolomycosis (see Basidiobolomycosis, [[Basidiobolomycosis]])
  • Coccidioidomycosis (see Coccidioidomycosis, [[Coccidioidomycosis]])
    • Clinical: pronounced eosinophilia may be an early indicator of dissemination
  • Cryptococcosis (see Cryptococcosis, [[Cryptococcosis]])
    • Epidemiology: [Cryptococcal pneumonia simulating chronic eosinophilic pneumonia. South Med J. 1995;88:845-846]
  • Histoplasmosis (see Histoplasmosis, [[Histoplasmosis]])
  • Paracoccidioidomycosis (see Paracoccidioidomycosis, [[Paracoccidioidomycosis]])

Parasitic

  • Angiostrongyliasis Cantonensis
  • Angiostrongyliasis Costaricensis
  • Ascariasis (see Ascariasis, [[Ascariasis]])
  • Cysticercosis (see Cysticercosis, [[Cysticercosis]])
  • Cystoisosporiasis (see Cystoisosporiasis, [[Cystoisosporiasis]])
    • Cystoisospora (Isospora) Belli
  • Dientamoebiasis (see Dientamoebiasis, [[Dientamoebiasis]])
    • Dientamoeba Fragilis
  • Echinococcosis (see Echinococcosis, [[Echinococcosis]])
  • Filariases
    • Dirofilariasis (see Dirofilariasis, [[Dirofilariasis]])
    • Loiasis
    • Lymphatic Filariasis
      • Brugia
      • Wuchereria
    • Mansonelliasis
      • Mansonella Ozzardi
      • Mansonella Perstans
      • Mansonella Streptocerca
    • Onchocerciasis (River Blindness) (see Onchocerciasis, [[Onchocerciasis]])
    • Tropical Pulmonary Eosinophilia (Occult Filariasis) (see Tropical Pulmonary Eosinophilia, [[Tropical Pulmonary Eosinophilia (Occult Filariasis)]])
  • Flukes
  • Gnathostomiasis
  • Hookworm
    • Ancylostoma Duodenale
    • Necator Americanus
  • Sarcocystosis (see Sarcocystosis, [[Sarcocystosis]])
    • Sarcocystis
  • Scabies (see Scabies, [[Scabies]])
  • Strongyloidiasis (see Strongyloidiasis, [[Strongyloidiasis]])
  • Trichinosis (see Trichinosis, [[Trichinosis]])
  • Visceral Larva Migrans (see Visceral Larva Migrans, [[Visceral Larva Migrans]])
    • Baylisascaris Procyonis
    • Toxocara Canis
    • Toxocara Catis

Pulmonary Infiltrates with Eosinophilia (see Pulmonary Infiltrates with Eosinophilia, [[Pulmonary Infiltrates with Eosinophilia]])

  • Acute Eosinophilic Pneumonia (see Acute Eosinophilic Pneumonia, [[Acute Eosinophilic Pneumonia]])
  • Acute Lung Transplant Rejection (Acute Cellular Lung Transplant Rejection) (see Acute Lung Transplant Rejection, [[Acute Lung Transplant Rejection]]): peripheral eosinophilia may occur with/without pulmonary infiltrates (as acute rejection may be detected by surveillance bronchoscopy with transbronchial biopsy prior to the development of pulmonary infiltrates)
  • Allergic Bronchopulmonary Aspergillosis (ABPA) (see Allergic Bronchopulmonary Aspergillosis, [[Allergic Bronchopulmonary Aspergillosis]])
  • Allergic Bronchopulmonary Candidiasis (see Candida, [[Candida]])
  • Bronchocentric Granulomatosis (see Bronchocentric Granulomatosis, [[Bronchocentric Granulomatosis]])
  • Chronic Eosinophilic Pneumonia (see Chronic Eosinophilic Pneumonia, [[Chronic Eosinophilic Pneumonia]])
  • Churg-Strauss Syndrome (see Churg-Strauss Syndrome, [[Churg-Strauss Syndrome]])
  • Dirofilariasis (see Dirofilariasis, [[Dirofilariasis]])
  • Drug-Induced Pulmonary Eosinophilia (see Drug-Induced Pulmonary Eosinophilia, [[Drug-Induced Pulmonary Eosinophilia]])
  • Eosinophilia-Myalgia Syndrome (see Eosinophilia-Myalgia Syndrome, [[Eosinophilia-Myalgia Syndrome]])
  • Langerhans Cell Histiocytosis (see Langerhans Cell Histiocytosis, [[Langerhans Cell Histiocytosis]])
    • Clinical: peripheral eosinophilia is not commonly seen
  • Hypereosinophilic Syndrome (see Hypereosinophilic Syndrome, [[Hypereosinophilic Syndrome]])
  • Sarcoidosis (see Sarcoidosis, [[Sarcoidosis]])
  • Simple Pulmonary Eosinophilia (Loffler’s Syndrome) (see Simple Pulmonary Eosinophilia, [[Simple Pulmonary Eosinophilia (Lofflers Syndrome)]])
  • Tropical Pulmonary Eosinophilia (Occult Filariasis) (see Tropical Pulmonary Eosinophilia, [[Tropical Pulmonary Eosinophilia (Occult Filariasis)]])
  • Visceral Larva Migrans (see Visceral Larva Migrans, [[Visceral Larva Migrans]])
  • Other Infections
    • Brucellosis (see Brucellosis, [[Brucellosis]])
      • Epidemiology: case reports [Eosinophilia and pneumonitis in chronic brucellosis: a report of two cases. Ann Intern Med. 1942;16:995-1001]
    • Coccidioidomycosis (see Coccidioidomycosis, [[Coccidioidomycosis]])
      • Clinical: pronounced eosinophilia may be an early indicator of dissemination
    • Cryptococcosis (see Cryptococcosis, [[Cryptococcosis]])
      • Epidemiology: [Cryptococcal pneumonia simulating chronic eosinophilic pneumonia. South Med J. 1995;88:845-846]
    • Echinococcosis (see Echinococcosis, [[Echinococcosis]])
    • Histoplasmosis (see Histoplasmosis, [[Histoplasmosis]])
    • Human Immunodeficiency Virus (HIV) (see Human Immunodeficiency Virus, [[Human Immunodeficiency Virus]])
    • Mycobacterium Simiae (see Mycobacterium Simiae, [[Mycobacterium Simiae]])
      • Epidemiology: [Acute eosinophilic pneumonia as a reversible cause of noninfectious respiratory failure. N Engl J Med. 1989;321:569- 574]
    • Paragonimiasis (see Paragonimiasis, [[Paragonimiasis]])
    • Schistosomiasis (see Schistosomiasis, [[Schistosomiasis]])
    • Trichinosis (see Trichinosis, [[Trichinosis]])
    • Tuberculosis (see Tuberculosis, [[Tuberculosis]])

Malignancy

Myeloproliferative Neoplasm

Lymphoid Neoplasm

  • Acute Lymphocytic (Lymphoblastic) Leukemia (see Lymphocytic, [[Acute Lymphocytic Leukemia]])
  • Angioimmunoblastic T-Cell Lymphoma (AITL) (see Lymphoma, [[Lymphoma]])
  • Autoimmune Lymphoproliferative Syndrome (ALPS) (see Autoimmune Lymphoproliferative Syndrome, [[Autoimmune Lymphoproliferative Syndrome]])
  • B-Cell Lymphoma (see Lymphoma, [[Lymphoma]])
  • Hodgkin’s Disease (see Hodgkins Disease, [[Hodgkins Disease]])
  • Sezary Syndrome (see Sezary Syndrome, [[Sezary Syndrome]])
  • T-Cell Leukemia/Lymphoma
  • T-Cell Lymphoblastic Lymphoma

Other

  • Adenocarcinoma
    • Gastrointestinal Tract: stomach, colon
    • Lung
    • Squamous Epithelium: cervix, vagina, penis, skin, nasopharyngeal, bladder
  • Systemic Mastocytosis (see Systemic Mastocytosis, [[Systemic Mastocytosis]])

Allergic Disorders

  • Allergic Rhinitis (see Allergic Rhinitis, [[Allergic Rhinitis]])
    • Clinical: mild-moderate eosinophilia
  • Asthma (see Asthma, [[Asthma]])
    • Clinical: mild-moderate eosinophilia (<1500 eosinophils per uL)
  • Atopic Dermatitis (see Atopic Dermatitis, [[Atopic Dermatitis]])
  • Allergic Fungal Rhinosinusitis (see Chronic Rhinosinusitis, [[Chronic Rhinosinusitis]])
  • Chronic Rhinosinusitis with Nasal Polyposis (see Chronic Rhinosinusitis, [[Chronic Rhinosinusitis]])

Immunodeficiency Syndrome

Primary Immunodeficiency

  • Hyper IgE-Recurrent Infection Syndrome (Job’s Syndrome, Buckley-Job Syndrome) (see Hyper IgE-Recurrent Infection Syndrome, [[Hyper IgE-Recurrent Infection Syndrome]])
  • IPEX
  • Omenn Syndrome: severe form of combined immunodeficiency
  • ZAP-70 Deficiency

Acquired Immunodeficiency/Inflammation

  • Bone Marrow Transplant/Stem Cell Transplant with Graft vs Host Disease (see Graft vs Host Disease, [[Graft vs Host Disease]])
  • Bullous Pemphigoid (see Bullous Pemphigoid, [[Bullous Pemphigoid]])
  • Dermatitis Herpetiformis (see Dermatitis Herpetiformis, [[Dermatitis Herpetiformis]])
  • Inflammatory Bowel Disease
  • Pemphigus Vulgaris (see Pemphigus Vulgaris”>Pemphigus Vulgaris, [[Pemphigus Vulgaris]])
  • Sarcoidosis (see Sarcoidosis, [[Sarcoidosis]])
    • Epidemiology: peripheral eosinophilia occurs in 41% of cases [MEDLINE]
  • Serosal Surface Irritation
    • Chemical
    • Mechanical
    • Radiation
  • Solid Organ Transplant Rejection

Rheumatologic Diseaase

Hypereosinophilic Syndrome (see Hypereosinophilic Syndrome, [[Hypereosinophilic Syndrome]]) [MEDLINE]

Myeloproliferative Type

  • Myeloproliferative Hypereosinophilic Syndrome
    • PDGFRA Rearrangements
    • PDGFRB Rearrangements
    • FGFR1 Rearrangements
    • JAK Point Mutation/Translocation
    • Deletion of 4q12 -> FIPIL1-PDGFRA Fusion
  • Chronic Eosinophilic Leukemia (see Chronic Eosinophilic Leukemia, [[Chronic Eosinophilic Leukemia]])
    • Clinical: clonal eosinophilia

Lymphocytic Type

  • General Comments
    • Physiology: aberrant T-cells which produce IL-5
  • Clonal T-Cells
  • No T-Cell Clone

Familial Hypereosinophilic Syndrome

  • Epidemiology: autosomal dominant
  • Physiology: mapped to 5q 31-33
  • Clinical: asymptomatic eosinophilia present from birth

Organ-Restricted Eosinophilic Disorders

  • General Comments
    • Clinical: peripheral eosinophilia with single organ involvement (with eosinophilic organ infiltration)
  • Chronic Eosinophilic Pneumonia (see Chronic Eosinophilic Pneumonia, [[Chronic Eosinophilic Pneumonia]])
  • Eosinophilic-Associated Gastrointestinal Disorders (EGID)
  • Eosinophilic Dermatitis/Cellulitis (Wells Syndrome) (see Eosinophilic Dermatitis, [[Eosinophilic Dermatitis]])
  • Eosinophilic Intrinsic Asthma (see Asthma, [[Asthma]])
    • Clinical: mild-moderate eosinophilia (<1500 eosinophils per uL)
  • Eosinophilic Sinus Disease

Associated Hypereosinophilic Syndrome

  • General Comments
    • Clinical: marked peripheral eosinophilia
  • Gleich Syndrome (Episodic Angioedema with Eosinophilia) (see Gleich Syndrome, [[Gleich Syndrome]])
  • Inflammatory Bowel Disease
    • xxxx
    • xxxx
  • Churg-Strauss Syndrome (Eosinophilic Granulomatosis with Polyangiitis, EGPA) (see Churg-Strauss Syndrome, [[Churg-Strauss Syndrome]])

Idiopathic Hypereosinophilic Syndrome

  • Clinically Variable

Drug Rash with Eosinophilia and Systemic Symptoms (DRESS) (see Drug Rash with Eosinophilia and Systemic Symptoms, [[Drug Rash with Eosinophilia and Systemic Symptoms]])

Drugs

Other

  • Acute Lung Transplant Rejection (Acute Cellular Lung Transplant Rejection) (see Acute Lung Transplant Rejection, [[Acute Lung Transplant Rejection]])
  • Adrenal Insufficiency (see Adrenal Insufficiency, [[Adrenal Insufficiency]])
  • Angiolymphoid Hyperplasia with Eosinophilia (Epithelioid Hemangioma)
  • Cholesterol Emboli Syndrome (see Cholesterol Emboli Syndrome, [[Cholesterol Emboli Syndrome]])
  • Contaminated Rapeseed Oil (see Contaminated Rapeseed Oil, [[Contaminated Rapeseed Oil]])
  • Eosinophilic Pustular Folliculitis
  • Eosinophilic Ulcer of the Oral Mucosa
  • Hemodialysis (see Hemodialysis, [[Hemodialysis]])
    • Clinical: mild eosinophilia may occur
  • Kimura Disease
  • Nodules/Eosinophilia/Rheumatism/Dermatitis/Swelling (NERDS)
  • Renal Transplant Rejection (see Renal Transplant, [[Renal Transplant]])

Diagnosis

Complete Blood Count (CBC) (see Complete Blood Count, [[Complete Blood Count]])

  • Determination of Absolute Eosinophil Count: multiply percentage of eosinophils x total WBC count
    • Normal Absolute Eosinophil Count: 0-500 eosinophils per uL (<0.5 x 10 to the ninth/L)
  • Eosinophilia
    • Low Eosinophil Count: more likely to be due to asthma or allergic rhinitis
    • High Eosinophil Count (>20k eosinophils/uL): more likely to be associated with a myeloproliferative malignancy

References

  • Eosinophilia and pneumonitis in chronic brucellosis: a report of two cases. Ann Intern Med. 1942;16:995-1001
  • Acute eosinophilic pneumonia as a reversible cause of noninfectious respiratory failure. N Engl J Med. 1989;321:569- 574
  • Cryptococcal pneumonia simulating chronic eosinophilic pneumonia. South Med J. 1995;88:845-846
  • Peripheral blood eosinophilia in association with sarcoidosis. Mayo Clin Proc 2000; 75(6)6: 586-590 [MEDLINE]
  • Refining the definition of hypereosinophilic syndrome. J Allergy Clin Immunol. 2010 Jul;126(1):45-9. doi: 10.1016/j.jaci.2010.03.042 [MEDLINE]