Eosinophilia

Terminology

1. Eosinophilia is defined as an absolute count >500

2. Mild 500-1500, Moderate 1500-5000, Severe >5000

3. Hypereosinophilia is >1500 with or without end organ damage

4. Hypereosinophilic syndrome is a count >1500, on 2 separate occasions, PLUS organ dysfunction

Etiology, think CHINA

1. C – Collagen vascular disease (EGPA)

2. H – Helminthic (parasites, Strongyloides)

3. I – Idiopathic hypereosinophilic syndrome

4. N – Neoplasia (lymphomas most common)

5. A – Allergy, atopy, asthma, drug induced (carbamazepine, sulfonamides)

Think Neoplastic disease!

1. For severe eosinophilia, need to rule out neoplasm including

   1. Primary hypereosinophilic syndrome

   2. Acute or chronic eosinophilic leukemia

   3. B-cell or T-cell leukemia / lymphoma

2. Sezary syndrome

   1. Type of cutaneous T cell lymphoma (CTCL)

   2. Presents with erythroderma (erythema covering at least 80% of body surface area), lymphadenopathy, and pruiritic skin

   3. Can see increased serum IgE, eosinophilia, and Sezary cells – mononuclear cells with grooved cerebriform nuclei seen on peripheral smear