Focal Eosinophilic Infiltration Research Articles

Eosinophilic Esophagitis Presenting with Dyspepsia and Anorexia

Purpose: Eosinophilic esophagitis (EoE) is characterized by an eosinophilic infiltration of the esophagus and is increasingly recognized as a cause of dysphagia and heartburn unresponsive to antireflux therapy. We report a case of eosinophilic esophagitis that presented without dysphagia, heartburn or endoscopic abnormalities to alert clinicians to the importance doing of esophageal biopsies in atypical presentations of EoE. Methods: A 19 yo college student presented with a 3 year history of anorexia and dyspepsia. Multiple foods and milk seemed to cause dyspepsia. However, his symptoms persisted despite avoiding milk and milk products. He had several episodes of minor hematemesis that led to an endoscopy at age 16 (by a different physician) showing only a small Mallory-Weiss tear and normal duodenal biopsies. Because of worsening symptoms and weight loss of ten pounds, he was referred for further evaluation. Family history was notable for mother with celiac sprue. A gastric emptying test was normal, LFTs and CBC were normal except for borderline eosinophilia; WBC = 7000/uL and 7.3% eosinophils (normal 0–7.0%). A full panel of celiac antibodies were negative except for an antigiadin IgG of 100.0 U/ml (normal <10.0 U/ml). A repeat endoscopy to assess for celiac sprue was normal except for slight gastric retention. Multiple biopsies were negative for celiac sprue and H. pylori. There was no eosinophilia in the duodenal or gastric biopsies. The esophagus was endoscopically normal without evidence of esophagitis, rings, or any other abnormalities. Biopsies from a normal appearing GE junction revealed a focal dense eosinophilic infiltration in the squamous epithelium (≥28 eosinophils per high powered field) consistent with EoE. The patient was started on fluticasone swallowed twice a day with resolution of all symptoms within a few weeks. Results: EoE is becoming more frequently diagnosed as a cause of dysphagia and heartburn and is predominantly considered in younger patients presenting with symptoms that are unresponsive to antireflux therapy or with endoscopic signs of EoE such as ringed esophagus. Diagnosis is by clinical features supported by esophageal biopsy with ≥15 eosinophils per HPF. Five biopsies (including proximal esophagus) have a sensitivity of 100%. Other bloodwork and endoscopic findings are neither sensitive nor specific. Conclusion: This case highlights the importance of esophageal biopsies in the diagnosis of EoE in atypical presentations. We suggest that clinicians consider the possibility of EoE in patients with prolonged, non-specific upper GI complaints and biopsy the esophagus even if the mucosa appears normal on endoscopy.

MRI Findings of Focal Eosinophilic Liver Diseases

The purpose of this study was to describe the MRI findings of focal eosinophilic infiltration and eosinophilic abscess of the liver. MRI shows characteristic findings of focal eosinophilic liver disease that can be helpful in differentiating lesions of focal eosinophilic liver disease from other focal liver lesions. In addition, eosinophilic abscess and focal eosinophilic infiltration showed different MRI findings from each other.

MR Findings in Eosinophilic Infiltration of the Liver

This study describes the findings of magnetic resonance imaging (MRI) of focal eosinophilic infiltration of the liver. Contrast-enhanced MR images of 8 patients with focal hepatic eosinophilic infiltration were reviewed retrospectively. We evaluated the signal intensity of focal lesions in T1-weighted and T2-weighted images and the pattern of enhancement in a dynamic contrast study. A total 22 focal hepatic lesions were observed; the lesions were isointense (55%) or hypointense (45%) on T1-weighted images and isointense (14%) or hyperintense (86%) on T2-weighted images. The arterial phase of the contrast study revealed 11 hyperintense lesions (50%). During the portal and delayed phases, 18 (82%) and 17 lesions (77%) were hyperintense, respectively. The focal eosinophilic infiltrations showed homogeneous enhancement in the portal and delayed phases in the dynamic contrast MR study. These findings should help to distinguish focal eosinophilic infiltration, especially from metastasis in patients with malignancy.

Focal eosinophilic infiltration of the liver mimicking hepatocellular carcinoma: Case reports

Focal eosinophilic infiltration is a rare disease entity that in patients with malignancies may mimic malignant hepatic nodules. We describe two cases in which focal eosinophilic infiltration of the liver, as well as primary liver cancer, occurred. In these patients, imaging findings similar to those observed in hepatocellular carcinoma (HCC) were noted: Enhancement at dynamic magnetic resonance (MR) imaging substantially increased perfusion at computed tomography during hepatic arteriography (CTHA) and a perfusion defect at computed tomography during arterial portography (CTAP).

Focal eosinophilic infiltration in the liver: radiologic findings and clinical course

We investigated the radiologic findings and clinical course of focal eosinophilic infiltration in the liver. We retrospectively reviewed computed tomographic (CT) and sonographic scans in 20 patients (18 male, two female; mean age, 50 years) with pathologically or clinically proven focal eosinophilic infiltration in the liver by two experienced radiologists in our institute from August 1995 to June 1999. We also correlated radiologic findings with peripheral eosinophil count. Radiologic and clinical findings during the follow-up (range, 2-49 months; mean, 19.5 months) also were analyzed. Clinical symptoms and signs included abdominal pain (n = 4), easy fatigability (n = 3), weight loss (n = 1), and peripheral eosinophilia (n = 19). Twelve patients were asymptomatic. On sonographic examinations, all lesions were seen as focal, low echoic nodules. On CT, the lesions appeared isoattenuated or low attenuated in the arterial phase and low attenuated in the portal phase, except one case that showed high attenuation in the arterial phase. The margins of most lesions appeared poorly defined. Lesions were single (n = 9) and multiple: two to five (n = 6), six to 10 (n = 3), and more than 10 (n = 2). Each lesion was smaller than 2 cm; only one was 4 cm in diameter. The distribution of the lesion was subcapsular in 14 patients and central in five. Diffuse dissemination was observed in one. Eosinophil-associated abnormality was not present in other abdominal organ in all cases. The peripheral eosinophil count correlated closely with the number but not with the size of lesions. Sixteen patients who had follow-up images showed complete (n = 14) or partial regression of the lesions with a decrease in size (n = 1) or number (n = 1) after 2-22 months (mean, 6.4 months). Focal eosinophilic infiltration in the liver had somewhat characteristic radiologic findings on sonography and CT. In the correct clinical context of peripheral eosinophilia and self-limited course, these radiologic findings may be helpful in differentiating this condition from other focal hepatic lesions.

Radiographic manifestations of eosinophilic gastroenteritis.

Eosinophilic gastroenteritis (EG) is a rare inflammatory disease of unknown etiology, characterized by focal or diffuse eosinophilic infiltration of the gastrointestinal tract. Although little over 250 cases of EG have been reported in the literature, EG is probably more common than reports in the literature would indicate. A retrospective review of 25 patients with EG along with a review of the literature was done to identify clinical, laboratory, radiographic, and therapeutic features. An allergic disorder was present in 14 (56%) and a peripheral eosinophilia was present in 24 (96%) of our patients. The most common radiographic manifestations of the stomach and small bowel included stenosis and fold thickening, respectively. Thirteen patients had esophageal involvement, with the esophageal stricture being the most common abnormality found in these patients. Steroids produced a good therapeutic result in most patients; the remaining patients responded to cromolyn and/or surgery.

Cardiotoxicity of human recombinant interleukin-2 in rats. A morphological study.

One of the side effects of interleukin 2 (IL-2) cancer immunotherapy in humans is the vascular leak syndrome, which is frequently associated with depression of myocardial function, myocarditis, and myocardial necrosis. To investigate this cardiotoxicity, IL-2 (three doses of 5 x 10(5) Cetus units/day i.p.) was given to rats for 2, 3, or 5 days. Heart, lung, liver, spleen, and kidney tissues were studied by light and electron microscopy and with immunoperoxidase techniques. Cardiac changes consisted of focal lymphocytic and eosinophilic infiltration, myocyte vacuolization, myofibrillar loss, and necrosis. Ultrastructural alterations included swelling of endothelial cells, with dissociation of intercellular junctions, migration of lymphocytes into the interstitium, and interstitial hemorrhage and edema. Close contact between infiltrating lymphocytes, particularly large granular lymphocytes, and cardiac myocytes was often observed in areas of tissue damage. All lesions were more severe on day 5 than on days 2 and 3. Immunoperoxidase stains demonstrated asialo GM1 ganglioside antibody-positive, granular lymphocytes to be much more frequent in myocardium of IL-2-treated rats than in that of control rats. Although we cannot exclude the possibility of a direct toxic effect of IL-2 on myocytes, our observations suggest that the myocardial damage produced by this agent is triggered by IL-2-activated lymphocytes that exert cytolytic effects, first on endothelial cells and then on cardiac myocytes, thus producing lesions that involve both the cardiac microcirculation and the muscle cells.