AM Report Pearls: CUSHINGOID features and Ddx of Eosinophilia!

AM Report Pearls: CUSHINGOID Features!

Coagulation difficulties (easy bruising/bleeding), Cataracts

Ulcers

Striae, Skin Thinning

Hump, Hypertension, Hirsutism

Infections (at higher risk for)

Neuropsychiatric manifestations, AVN of joints

Gynecomastia

Obesity, Osteoporosis

Inflammation, Impaired wound healing

Diabetes, Depression

AM Report Pearls: Ddx of Eosinophilia

  • At what level are we concerned?
    • Absolute eos count of >600eos/microL
    • Mild: 600-1500, mod: 1500-5000, severe: >5000
    • Hypereosinophilia: AEC >1500, can be assoc with organ damage regardless of cause
    • Hypereosinophilic syndrome: sustained hypereos (>1500 for 6mos and organ damage)
    • Can be primary, secondary, or idiopathic (some case series show 50% idiopathic)
  • What is our initial evaluation?
    • Travel and drug history
    • Stool O&P x2-3
    • Other testing only if indicated
  • Differential Diagnosis for Eosinophilia
    • Most common causes in US: Atopic disorders, Parasitic infections, Tumors
    • Reminder of a mnemonic is NAACP
    • Neoplastic: esp Hodgkin’s and NHL, Leukemias, metastatic cancers, (Cervical cancer; Ovarian Cancer; SCC of vagina, penis, skin, and nasopharynx; Gastric and colon adenoca, Urothelial (transitional cell) ca of the bladder)
    • Atopic/Allergic/Asthma/ABPA
    • Adrenal insufficiency
    • Churg-Strauss (uncommon in collagen vascular disease)
    • Parasitic – check 3 stool O&P specimens
      • Single-cell protozoan infections usually do NOT cause eosinophilia (Giardia and Entamoeba)
    • Also: HIV, meds (Sulfa, gold, carbemazepine, NSAIDs, beta-lactams/cephalosporins, ranitidine, allopurinol, phenytoin), Cocci
      • Idiopathic eosinophilic synovitis (large effusion without warmth, erythema, or pain 12-24h after trauma to joint)
      • Cholesterol embolization – inc ESR, hypocomplementemia, thrombocytopenia, eosinophilia, eosinophiluria, renal insufficiency, livedo reticularis, purple toes
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