Eosinophilia is defined by absolute eosinophilia count (AEC) > 500
Hypereosinophilia is >1500
Hyperesoinopholic Syndrome (HES) is >1500 and associated organ dysfunction
-- History: *** recent changes in meds/supplements, diet, ID social hx (infectionss, travel, exposures, etc), atopy, malignancies, rheum dx
-- Clinical/Exam: *** rashes, pulm dx, nasal/sinus involvement, LAD, hepatosplenomegaly
-- Data: *** see below
-- Etiology/DDx: *** Primary (HES, leukemia) vs Secondary (infection – helminth, fungal, protozoan, autoimmune – EGPA; allergies – drugs like PCN/cephalosporins, DRESS, atopy, ABPA, hyper IgE, AIN; cholesterol emboli)
The patient's HPI is notable for ***. Exam showed ***. Labwork and data were notable for ***. Taken together, the patient's presentation is most concerning for ***, with a differential including ***.
-- If absolute eosinophil count (AEC) >100,000, c/f leukostasis, or c/f cardiac/neuro/VTE involvement - 1mg/kg of methylpred, otherwise can take time to diagnose and treat the underlying condition
-- Labs – trop, B12, UA, CK; deep cuts – strongyloides serology, stool O+P, ANCA, ANA, IgE levels
-- Imaging – CXR, can consider CT C/A/P
-- If c/f Pulm etiology – CT chest and bronch, aspergillus IgE
-- If c/f GI etiology – CTAP and endoscopy
-- If c/f cardiac etiology – TTE and Cardiac MRI
-- If c/f malignancy or primary eosinophilia – peripheral flow and BMBx
PDF coming soon!