RATIONALE: We report the first case of eosinophilia from a bovine dural graft.METHODS: The patient's medical record was reviewed. The literature was reviewed for cases of eosinophilia related to a bovine dural graft.RESULTS: An 18 year old female with spina bifida presented with unexplained fever, erythroderma and eosinophilia. Ten weeks previously, she underwent surgical correction of a tethered spinal cord with bovine dural patch placement. Three weeks postoperatively she became febrile and methicillin resistant Staphylococcus aureus was cultured from the surgical site. Despite appropriate intravenous antibiotics, the patient remained febrile for several weeks. An erythematous, desquamating, pruritic erythroderma developed that was attributed to a possible drug reaction. All medications were stopped but the rash persisted. A peripheral eosinophilia to 6,300 x 10(9)/L developed as did transaminitis, hypoalbuminemia and anemia. Autoantibody and parasite serologies were negative and an indwelling central venous catheter was removed. On 2 separate occasions systemic corticosteroids successfully treated the fever and rash. Unfortunately, both returned whenever corticosteroids were stopped. Serum specific IgE was class 2 positive to beef (1.20 kU/L), and an intradermal injection of bovine collagen resulted in 5X3 mm area of induration at 24 hours. The bovine dural patch was removed, and pathology revealed moderate eosinophilic and chronic lymphocytic inflammation as well as a noncaseating granulomatous reaction. The fever, rash and eosinophilia resolved without postoperative corticosteroids. The 5 week postoperative eosinophil count was 800 x 10 (9)/L.CONCLUSIONS: Allergy to acellular bovine graft material should be considered in the differential diagnosis when evaluating fever, erythroderma and eosinophilia. RATIONALE: We report the first case of eosinophilia from a bovine dural graft. METHODS: The patient's medical record was reviewed. The literature was reviewed for cases of eosinophilia related to a bovine dural graft. RESULTS: An 18 year old female with spina bifida presented with unexplained fever, erythroderma and eosinophilia. Ten weeks previously, she underwent surgical correction of a tethered spinal cord with bovine dural patch placement. Three weeks postoperatively she became febrile and methicillin resistant Staphylococcus aureus was cultured from the surgical site. Despite appropriate intravenous antibiotics, the patient remained febrile for several weeks. An erythematous, desquamating, pruritic erythroderma developed that was attributed to a possible drug reaction. All medications were stopped but the rash persisted. A peripheral eosinophilia to 6,300 x 10(9)/L developed as did transaminitis, hypoalbuminemia and anemia. Autoantibody and parasite serologies were negative and an indwelling central venous catheter was removed. On 2 separate occasions systemic corticosteroids successfully treated the fever and rash. Unfortunately, both returned whenever corticosteroids were stopped. Serum specific IgE was class 2 positive to beef (1.20 kU/L), and an intradermal injection of bovine collagen resulted in 5X3 mm area of induration at 24 hours. The bovine dural patch was removed, and pathology revealed moderate eosinophilic and chronic lymphocytic inflammation as well as a noncaseating granulomatous reaction. The fever, rash and eosinophilia resolved without postoperative corticosteroids. The 5 week postoperative eosinophil count was 800 x 10 (9)/L. CONCLUSIONS: Allergy to acellular bovine graft material should be considered in the differential diagnosis when evaluating fever, erythroderma and eosinophilia.