Morning Report 11/20

Today we had an excellent morning report case presented by none other than Dr. Arnold. Our patient had an unclear cause of lymphadenopathy with eosinophilia.

A couple of quick learning points from this morning;

  1. 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
  2. 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)
  3. 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

 

SA

 

Picture from Immense Immunology, https://immense-immunology-insight.tumblr.com/post/62418260049/more-causes-of-eosinophilia-i-couldnt-fit-them

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