SFGH 4.20 pearls: Eosinophilia

  • Eosinophilia is an absolute eos count >500. It is divided into mild (500-1500), moderate (1500-5000) and severe (>5000)
    • Organ damage can occur at any elevation and work up is indicated for anyone symptomatic with eos >500 or asymptomatic with eos >1500 on 2 occasions.
  • Hyperesosinophilic syndrome (HES) is hypereosinophilia (eos >1500) on at least 2 occasions and any organ dysfunction due to the eosinophils.
    • Hyperesosinophilia without end organ damage is considered “hyperesosinophilia of unknown significance” (HEUS)
    • The most common organs affected are the skin, lungs and GI tract, though cardiac and CNS tissue can be affected
  • There are many etiologies, but the major categories are:
    • Allergic – atopy, med allergy
    • Infectious – helminths, some fungal infections
    • Heme/neoplastic – primary hypereosinophilic syndrome, leukemia, lymphoma, mastocytosis
    • Immune – some immunodeficiencies, transplant rejection
    • Endocrine – adrenal insufficiency
  • Treatment with steroids should be initiated immediately for patients with eos >100K, pulmonary symptoms, cardiac involvement or thromboemoli attributable to the hypereosinophilia.
    • For most other patients, the etiology can be further evaluated prior to starting treatment
    • Test for strongy and start empiric treatment with steroids for patients with potential exposure
    • Steriods typically reduce the eosinophil count by about 50% in 24 hours

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