Page 980 - Williams Hematology ( PDFDrive )

954 Part VII: Neutrophils, Eosinophils, Basophils, and Mast Cells Chapter 62: Eosinophils and Related Disorders 955

TABLE 62–4. Causes of an Eosinophilia
Frequency of Cause Usual Degree of
Disease of Eosinophilia Eosinophilia Comment
INFECTIONS
Parasitic disease Common worldwide Moderate to high
Bacterial Rare Almost invariably causes an eosinopenia
Mycobacterial Rare Secondary to drug therapy
Invasive fungal Unusual Apart from allergic responses which are common and
coccidiomycosis, in which as many as 88% of patients have
an eosinophilia
Rickettsial infections Rare
Yeast Rare Cryptococcus reported as causing cerebrospinal fluid
eosinophilia
Viral infections Rare Occasional case reports of an eosinophilia in a variety of viral
infections, including herpes and HIV infection
ALLERGIC DISEASES
Allergic rhinitis Common Mild
Atopic dermatitis Common especially Mild to moderate
children
Urticaria/angioedema Common Mild Eosinophils seen in skin even with normal count
Fungal allergy Common Mild to high Immunoglobulin (Ig) E sensitization to thermotolerant colo-
nizing yeast (e.g., Candida albicans) and molds, e.g., Aspergillus
fumigatus is a common cause of an eosinophilia
Asthma Common Mild Syndrome of intrinsic asthma, nasal polyps, and aspirin intoler-
ance associated with higher-than-usual eosinophil counts
DRUG REACTIONS
Many drugs Uncommon Mild to high Antibiotics, nonsteroidal antiinflammatory drug, and antipsy-
chotics commonest groups; count should return to normal on
stopping drug
NEOPLASMS
Acute eosinophil leukemia Rare High
Chronic eosinophilic Rare high See text on hypereosinophilic syndrome
leukemia
Myeloid leukemia Uncommon Moderate to high Raised eosinophil counts can be seen in chronic myeloid
leukemia
Lymphomas Uncommon Moderate Often intense tissue eosinophilia with moderate blood eosino-
phil count; Hodgkin disease commonest type
Histiocytosis X Rare Mild Intense tissue eosinophilia in eosinophilic granuloma but blood
eosinophilia unusual
Solid tumors Uncommon Mild to high Many different tumors reported
MUSCULOSKELETAL
Rheumatoid arthritis Rare Mild to high Occasional case reports. More usually secondary to therapy
Eosinophilic fasciitis Rare Moderate
GASTROINTESTINAL
Eosinophilic gastroenteritis Rare Mild to moderate Characterized by irritable bowel syndrome–like symptoms;
mucosal biopsies often normal
Eosinophilic esophagitis Increasingly mild Marked tissue eosinophilia with mild or absent blood
recognized eosinophilia
Celiac disease Uncommon Normal Tissue eosinophilia
Inflammatory bowel disease Eosinophils seen in biopsies in both Crohn and ulcerative colitis,
but blood eosinophilia unusual
Allergic gastroenteritis Rare Mild to high Young children
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