Terminology
Eosinophilia is defined as an absolute count >500
Mild 500-1500, Moderate 1500-5000, Severe >5000
Hypereosinophilia is >1500 with or without end organ damage
Hypereosinophilic syndrome is a count >1500, on 2 separate occasions, PLUS organ dysfunction
Etiology, think CHINA
C – Collagen vascular disease (EGPA)
H – Helminthic (parasites, Strongyloides)
I – Idiopathic hypereosinophilic syndrome
N – Neoplasia (lymphomas most common)
A – Allergy, atopy, asthma, drug induced (carbamazepine, sulfonamides)
Think Neoplastic disease!
For severe eosinophilia, need to rule out neoplasm including
Primary hypereosinophilic syndrome
Acute or chronic eosinophilic leukemia
B-cell or T-cell leukemia / lymphoma
Sezary syndrome
Type of cutaneous T cell lymphoma (CTCL)
Presents with erythroderma (erythema covering at least 80% of body surface area), lymphadenopathy, and pruiritic skin
Can see increased serum IgE, eosinophilia, and Sezary cells – mononuclear cells with grooved cerebriform nuclei seen on peripheral smear