Causes of Eosinophilia - Differential Diagnosis
Eosinophils: myeloid lineage-derived granulocytes that act as innate effector cells in Th2 immune responses. Pathology mediated by release of granule contents such as major basic protein (MBP), peroxidases (→ ROS), cytokines/chemokines, & enzymes
Eosinophilia: AEC >500. Hypereosinophilia: AEC >1500. Hypereosinophilic syndromes (HES): AEC >1500 + organ dysfunction.
- Eosinophils are quickly eliminated by steroids → eosinophilia may be unmasked as pts taper off chronic glucocorticoids.
Either primary and due to clonal expansion (HES/leukemia) or secondary (reactive) due to infection, atopy, meds, rheum dz, etc.
• Infections Helminth: Strongyloides, toxocariasis, shistosomiasis, ascaris, filariasis, trichinellosis. • •
• Fungal: Aspergillus (ABPA), coccidiomycosis, histoplasmosis. Protozoal: isospora. Viral: HIV, HTLV1/2.
• Malignancy: Primary HES (PDGFRA-assoc.), eosinophilic leukemia, NHL, HL, mastocytosis; less common with solid tumors.
• Autoimmune: EGPA (see Vasculitis), PAN, eosinophilic fasciitis, RA, IBD, IgG4, GVHD, blistering disease.
• Allergic: Drug or food allergy, DRESS Syndrome, ABPA, atopy, hyper IgE syndrome, AIN, episodic angioedema (Gleich synd.).
• Misc: Adrenal insufficiency, cholesterol emboli syndrome, acute arterial thrombosis.
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