Eosinophilia

Eosinophilia is an absolute eosinophil count greater than 700 cells^L, with primary and secondary causes. Secondary eosinophilia may result from immunodeficiency, neoplasms, collagen vascular disease, and dermatologic disorders. When seen in a family medicine setting, allergic disorders and infections caused by parasites are more likely causes of eosino-philia. The primary form of eosinophilia is often called hypereosinophilic syndrome (HES). Characteristics of HES are an eosinophil count higher than 1500 cells^L, longer than 6 months in duration, and evidence that eosinophils have infiltrated into tissues. Studies have shown that this may be a mutation in chromosome 4 that results in the linkage of the RHCE and PDGFRd genes. Clinical features are a rash, fever, cough, dyspnea, peripheral neuropathy, diarrhea, and development of congestive heart failure, with valvular abnormalities and mural thrombi. The blood smear reveals many eosinophils with vacuoles and decreased numbers of granules. The total WBC count may range from 10,000 to 30,000 WBCs^L, of which 30% to 70% are eosinophils. Care should be taken to eliminate severe allergic reactions, eosinophilic leukemias, and invasive parasitic infections before this diagnosis is firmly established. If there are cardiopulmonary problems, initial therapy with prednisone at high doses, followed by lower doses for up to 3 months or longer, is often successful. If this not helpful, hydroxyurea can be used to lower the WBC count to below 10,000 cells/^L.

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