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| A lonely pink eosinophil |
Not only is eosinophilia challenging to pronounce, but it is also a challenging diagnostic dilemma, as the differential diagnosis is quite broad and often involves invasive investigations to characterize the underlying etiology (bone marrow biopsy, tissue biopsies, etc.)
The basic approach is to classify the eosinophilia as either a secondary phenomenon, or a primary eosinophilia.
Within the differential for secondary causes of eosinophila are the following:
Infectious causes:
Tissue-invasive parasitosis (i.e. Strongyloides, Filariasis)
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| Strongyloides |
Noninfectious causes:
Drugs (Sulfa, CBZ)
Atopy / Allergies - asthma, atopic dermatitis
Autoimmune - eGPA, GPA (Churg-Strauss, Wegener's), Sarcoidosis
Malignancy - T-cell lymphoma, metastatic disease
Endocrine - Addison's disease
The differential for primary causes of eosinophilia is a collection of hematologic malignancies and myeloproliferative disorders:
Acute leukemias (AML)
Chronic Myeloid disorders - CML, and other molecular defined chronic myeloid disorders (8p11 Syndrome)
Clinicopathologically defined chronic myeloid disorders (MDS, PRV, mastocytosis)
Taking a thorough history is of critical importance, in terms of obtaining a detailed travel and exposure history that might suggest a parasitic infection. A history of atopy, or other symptoms of vasculitis (wrist drop, hematuria, fever, arthritis, etc.)
Reference:
Tefferi, A. Blood eosinophilia: a new paradigm in disease
classification, diagnosis, and treatment. Mayo Clinic Proceedings. 80(1):
75-83, 2005 Jan.
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