Numerous Eosinophils Research Articles

Incidence of cutaneous habronemosis in Manipuri ponies in India.

Information pertaining to parasitic fauna and parasitic diseases in Manipuri ponies in India is not available. Moreover, no systematic studies have been undertaken on cutaneous habronemosis in Manipuri ponies which is a common skin problem of Manipuri ponies as reported by pony owners. Keeping in the view of the importance of parasitic infections in veterinary health coverage particularly in Manipuri ponies, the present study was planned. A survey of natural cases of cutaneous habronemosis followed by molecular confirmation of species involved and treatments were done. Out of 200 ponies examined, nine cases (4.5%) of cutaneous habronemosis was recorded. Gross examination revealed raised and ulcerated wounds with necrotic tissues covered with yellowish-tan granulation. Histopathological study revealed eosinophilic granuloma and in the center of the granuloma with necrotic debris. Remnants of the Hebronema larvae with infiltrating neutrophils surrounded by proliferating fibrous tissue with numerous eosinophils, macrophages and lymphocytes were also observed. Molecular detection of Habronema sp. was confirmed by semi-nested PCR. Sequence analysis revealed larvae of H. muscae was the common spirurid species responsible for producing cutaneous habronemosis in Manipuri ponies. Subsequently, sequence submitted to NCBI GenBank and accession number obtained (MH038181). Surgical removal of necrotic tissue, ivermectin injection along with antibiotics successfully cured all the lesions in infected ponies.Results confirmed occurrence of cutaneous habronemosis in Manipuri ponies in India.

Clinical and histopathologic study of 39 patients with imported tungiasis.

Tungiasis is an infestation caused by the penetration into the skin of the flea Tunga penetrans. Histopathologic studies on imported tungiasis are rare and based on a limited number of cases. We carried out a review of 39 biopsy specimens collected from 39 patients with imported tungiasis. In all patients, ethnicity, gender, age, location, and clinical features of the lesions, Fortaleza classification and countries of infestation were recorded. Histopathologic study revealed hyper- parakeratosis and acanthosis. Fragments of the flea were located in the epidermis and upper dermis and were circumscribed by a pseudo-cystic cavity. Inside this cavity, we observed: the exoskeleton, made up of a thickened and eosinophilic cuticle; the striated muscle; the tracheal rings and the digestive organs (observed only in some specimens); the ovaries, very rich in eggs, and an inflammatory infiltrate, made up of lymphocytes and neutrophils, with numerous eosinophils. The hypodermic layer was never observed. Histopathologic examination is helpful for the correct diagnosis of tungiasis in travelers returning from tropical and subtropical countries in which the infestation may be characterized by an atypical clinical presentation.

Invasive and Allergic Complications Due to Aspergillus fumigatus in Allogeneic Hematopoietic Cell Transplantation (HCT) Primary Immunodeficiency (PID) Patients

Introduction Invasive aspergillosis may complicate up to 23% of HCT. Three patients with predispositions to infection with Aspergillus pre-transplant underwent reduced intensity conditioning HCT for unrelated PIDs: hypomorphic IL2R-γ deficiency (36 y/o man, P1), STAT3 mutated Hyper IgE syndrome (7 y/o girl, P2), and EBV-associated lymphoproliferative disease with mutated IκBα (30 y/o woman, P3). Methods Conditioning consisted of pentostatin/cyclophosphamide (Cy); patients 2 and 3 also received busulfan, with high dose Cy/sirolimus/mycophenolate mofetil for GVHD prophylaxis. P1 and P2 received micafungin prophylaxis and P3 continued pre-HCT posaconazole. Results P1 had preexisting bronchiectasis colonized by Aspergillus fumigatus. The transplant was complicated by fever, mild hemoptysis and new nodular infiltrates during neutropenia. Blood Aspergillus antigen index (AAI) was positive 2 days prior to engraftment and negative day 31. On day 30, peripheral blood eosinophils rose to 4,640/µl (22.9%). Eosinophilia abated with corticosteroids for cutaneous GVHD, but tapering steroids was complicated by increasing eosinophilia and cough. Biopsy (day 59) of the new lung lesions revealed necrotizing inflammation and septate hyphae. P2 had a preexisting large right pneumatocele. Fevers persisted from day 3 post-HCT and beyond engraftment (day 19). Sputum cultures grew A. fumigatus. Eosinophilia on day 35 (560/µl, 12.5%) reached 2640/µl (29.9%) on day 45. Antifungal therapy was continued and corticosteroids and tocilizumab were given, with rapid abatement of fevers, cough and eosinophilia. The blood AAI was positive on day 54 but became negative by day 61. On day 94 a right pneumothorax developed. Resection of the affected lung was performed on day 114. P3 had a left lung cavity aspergilloma and intermittent hemoptysis prior to transplantation. HCT was successfully performed under posaconazole/isavuconazole prophylaxis. Post-HCT, cough was difficult to control, and eosinophilia appeared (460/µl, 13.9%) on day 48 coincident with new diffuse nodular infiltrates, interpreted as bronchial spread of the cavity contents. Right lung lavage revealed numerous neutrophils and eosinophils and grew A. fumigatus. The patient underwent left upper lobectomy on day 83. Symptoms and eosinophilia improved. Conclusion Three patients predisposed to Aspergillus disease underwent successful HCT for different PIDs, but each case was complicated by a mixed picture of invasive Aspergillus infection and eosinophilic inflammation similar to allergic bronchopulmonary aspergillosis. Successful management included aggressive antifungal therapy, but corticosteroids were necessary to manage the allergic symptoms, and lung resection was performed in two cases.

An Image for Differential Diagnosis

It is the most common transient rash in healthy neonate, which is a benign, self-limiting, physiological rash affecting about 50% of term newborn. It is rarely seen in preterm infants. They usually begin at 1 to 2 days of age, but may occur at any time until about the fourth day. Blotchy erythematous macules 1 to 3 cm in diameter with a 1 to 4 mm central vesicle or pustule are seen in erythema toxicum neonatorum (ETN). Number of lesions can vary from one or two to several hundred. They are not only more profuse on the trunk, but also commonly appear on face and proximal limbs and spares palms and soles. The infant appears well, unperturbed by the eruption. Spontaneous recovery usually occurs within 3 to 7 days without any residual pigmentation . A smear of the central vesicle or pustule contents reveals numerous eosinophils on Wright stain preparations. No organisms can be seen or cultured. A peripheral blood eosinophilia of up to 20% may be associated with severe cases. No treatment is indicated and apprehensive parents can be reassured about the benign nature of the eruption.

Rhinoentomophthoromycosis: An uncommon but not rare fungal infection of the nose

Entomophthoromycosis is a group of fungal infections caused by fungus belonging to the order Entomophthorales. The two clinical forms of entomophthoromycosis identified are Basidiobolomycosis and Conidiobolomycosis. Rhino-facial conidiobolomycosis mainly affects the mucosa of the nares, nasal passages, nasal sinuses, nasopharynx, mouth and spreads to adjacent tissues causing disfigurement of face. Histological examinations and mycological cultures are the gold standard for confirmation of entomophthoromycosis. In our middle aged female patient, histopathology revealed fungal elements with broad aseptate hyphae surrounded by splendor hoeppli material and surrounding tissue showed dense inflammatory infiltrate with numerous eosinophils and foreign body granulomatous reaction. Treatment include both surgical and medical management, which includes systemic antifungals. Patient was initiated on itraconazole to which she responded. A significant reduction in the swelling and restoration of patency of the nostrils was noted on review after one month. Knowledge of rare fungal infections such as entomophthoromycosis is significant in clinical practice.

Angiolymphoid hyperplasia with eosinophilia treated with Mohs micrographic surgery

A 60-year-old healthy man presented with several enlarging, tender, spontaneously bleeding, and episodically pruritic nodules on his ear. Five agminated pink-red papulonodules of the superior postauricular sulcus were noted on examination. Pathological examination revealed a lobular dermal vascular proliferation with plump endothelial cells protruding into the lumen in a hobnail pattern, along with a dense perivascular inflammatory infiltrate composed of plasma cells, lymphocytes, and numerous eosinophils. The diagnosis of angiolymphoid hyperplasia with eosinophilia was confirmed. After discussing treatment modalities, the patient opted for Mohs micrographic surgery (MMS). Three stages of MMS were able to remove all large vessel involvement and clear the peripheral margins, but the tumor had a complex branching pattern of growth in the deep bed of the wound with numerous tiny foci remaining. Owing to risk of disfigurement, no further excision was undertaken. The area was reconstructed with a temporalis fascia flap and a full-thickness skin graft. Despite remaining microscopic disease, the patient remained without recurrence or symptoms at one year of follow up.

Incidental Jejunal Anisakiasis in a Patient Presenting With Small Bowel Obstruction

Anisakiasis is a parasitic infection of the gastrointestinal tract caused by the consumption of undercooked seafood containing larvae of Anisakis simplex. Its prevalence is higher in areas where fish is consumed raw, salted or lightly pickled. A 70-year-old Caucasian female presented with acute nausea, vomiting and periumbilical abdominal pain. She had a past medical history of inflammatory arthritis, on hydroxychloroquine, and a surgical history of three prior cesarean sections, hysterectomy and appendectomy. On exam, she had a distended abdomen and diffuse moderate tenderness to palpation with no rebound or guarding. Laboratory studies were unremarkable, with no eosinophilia. Computed Tomography showed a small bowel obstruction with a short segment closed loop in the left paramidline supraumbilical region. After failing conservative management, she underwent surgical exploration. The small bowel was found to be obstructed due to an internal hernia, which was surgically repaired and did not require bowel resection. While the small bowel was being run, a small one cm pedunculated mass attached to the serosal surface of the jejunum was incidentally encountered 15 centimeters distal to the Ligament of Treitz. This mass did not involve the portion of small bowel within the internal hernia. A 4 cm segment of small bowel including the mass was resected. Histopathology of the mass showed abscess formation with granulomatous inflammation, necrosis, chronic inflammation, foreign body multinucleated giant cells and numerous eosinophils. Deeper levels of the abscess showed an Anisakis type larva with a multilayered cuticle. Further history revealed that she eats raw seafood regularly, including eating lightly cooked fresh caught tuna two months prior to presentation. She recovered from her surgery and was discharged home.Humans become infected with Anisakis when they eat intermediate hosts, such as squid or fish that are undercooked or raw. The parasite will attempt to burrow in the intestinal wall, causing a granulomatous inflammation, which eventually results in the death of the parasite. Symptoms on presentation depends on the organ location of the invasion by the nematode. Gastric anisakiasis typically causes acute abdominal pain whereas intestinal anisakiasis can be more indolent and cause granulomatous inflammation, at times resembling Crohn's disease. Visualization of the parasite via upper endoscopy allows for diagnosis and removal, which is curative.2510 Figure 1. Histopathology of the mass showed abscess formation with granulomatous inflammation, necrosis, chronic inflammation, foreign body multinucleated giant cells and numerous eosinophils. Deeper levels of the abscess showed an Anisakis type larva with a multilayered cuticle.

Herbal Drugs: Friend or Foe?

We herein report a rather peculiar case of acute liver injury. A 78-year-old woman developed asthenia and weakness. Her previous medical history was irrelevant, except for having received etoricoxib 60mg/24h for osteoarthritis 1 month before. Liver biochemistry indicated hepatic failure; all tests for viral, bacterial, or parasitic infections were negative, as were the autoimmunity tests. As the patient's status gradually declined, a transjugular hepatic biopsy was obtained and confirmed hepatocyte necrosis with severe inflammation and presence of numerous eosinophils. Suspecting a potential toxic cause of the disorder, the patient was requestioned and admitted curcuma consumption for a long time. She was asked to discontinue it and her status gradually improved, with normalization of all the analytical parameters. On the long-term follow-up, she remains well. We consider that this case of acute liver injury can be explained with the combination of the acute toxic effect of a drug, etoricoxib, and the herbal remedy curcuma. This case is illustrative of the risk of interactions between drugs and natural remedies, and to the best of our knowledge, it is the first case of severe hepatotoxicity related to etoricoxib, probably potentiated by long-term curcumin intake. Besides, it illustrates the fact that patients do not generally consider natural remedies as potential source of toxicity, and this can lead to a delay in diagnosis.

INFLAMMATORY MYOPATHIES: P.162IgG-4 related myositis - a new entity among inflammatory myopathies

IgG4-related diseases (IgG4RD) are exceedingly rare, have only been recently discovered and the nosological spectrum is only beginning to be understood. Affected patients suffer from subacute non-specific general complaints often associated with organ-specific affection typically of the salivary or lacrimal glands, formation of so-called pseudo-tumours with fibrous characteristics, and interestingly often multi-organ affections. Gold standard for diagnosis of IgG4RD is the histopathological analysis, highlighting the characteristic lymphocytoplasmic infiltrates, storiform fibrosis and obliterative phlebitis in combination with IgG4-positive Plasma cells. We present a 55-year-old female patient with a 30-year history of atypical rheumatoid arthritis suffering from a 12-year history of axial muscle weakness including paravertebral muscles. No other organs were involved. Her laboratory markers included eosinophilia, elevated soluble IL-2 receptor and IgG4. On muscle biopsy an unusually dense lymphomonocytic infiltrate including numerous Eosinophils and Giant cells as well as numerous IgG4-positive plasma cells were detectable. In general, IgG4-RD responds well to treatment, especially to B cell depletion, however our patient did not. As a second-line treatment, she received a JAK1 and JAK2 inhibitor, which dramatically improved her muscle strength over a 3 months period. This report highlights that myositis can be the sole presentation of IgG4 related disease and that treatment may require alternative approaches, which in turn open speculations about pathophysiological underpinnings of the disease.

Takayasu\u2019s arteritis associated with eosinophilic gastroenteritis, possibly via the overactivation of Th17

BackgroundTakayasu’s arteritis (TA) is a large-vessel vasculitis pathologically characterized by granulomatous necrotizing vasculitis with giant cells. Although the cause of TA is still unclear, genetic factors as well as immunological abnormalities, particularly the overactivation of Th1 and Th-17, are considered to play important roles in the pathogenesis of this disease. Eosinophilic gastroenteritis (EGE) is a type of refractory inflammation in which numerous eosinophils infiltrate the inflammatory area. It is known that the overactivation of Th2 is associated with the pathogenesis of EGE, although the cause of EGE is still unclear. The immunological abnormalities in TA are therefore thought to be different from those in EGE. To date, no cases of complication of TA and EGE have been reported.Case presentationsAn 18 year-old female was diagnosed with EGE and treated with prednisolone. At 6 months after completion of the treatment, the patient experienced chest pain, and was diagnosed with TA. TH1 and TH17 immunity are thought to be involved with TA, while TH2 are considered to be involved with EGE. In this case, the expression of IL-17 mRNA in the colon mucosa greatly decreased after prednisolone treatment for EGE.ConclusionsThis is the first report of TA complicated with EGE, and the overactivation of TH17 is considered to be associated with the pathogenesis of these two diseases.

Treatment for Eosinophilic Otitis Media

Eosinophilic Otitis Media (EOM) is remarkably characterized by viscous middle ear effusion (MEE) infiltrated with numerous eosinophils. Since EOM is a high risk disease of progressive hearing loss, early diagnosis and management of appropriate treatment along with an understanding of the pathology of EOM are imperative. The treatment strategies for EOM comprise the removal of the highly viscous MEE enriched with a cytotoxic protein derived from eosinophils, and the suppression of local and systemic eosinophilic inflammation. Here, we introduce how we treat EOM patients in our department concretely. Regarding the management of the acute phase of EOM, topical and/or systemic steroids have proven their efficacy. Regarding the long-term management of EOM, a combination of various antiallergic drugs that have proven efficacy for eosinophilic inflammation is beneficial. In a considerable number of EOM cases, we have succeeded cessation of topical and systemic steroids.

Benign pleural schwannoma presenting with a large, blood-stained pleural effusion

A previously fit and well 43-year-old man presented with 8 weeks of worsening breathlessness and a dry cough. He was an ex-smoker of 10 pack-years with no history of asbestos...

Acute severe cutaneous methotrexate toxicity in a patient with rheumatoid arthritis: Report of a rare side effect

Background: Skin lesions due to acute methotrexate (MTX) toxicity are rare. The majority of cases of cutaneous MTX toxicity have been reported in patients with psoriasis, exceptionally in patients with rheumatoid arthritis (RA). We report a case of RA who had an acute severe cutaneous MTX toxicity and its management. Case presentation: A 59year old woman who has been followed up in Rheumatology department in Farhat Hached Hospital in Sousse in Tunisia since 2005 for RA. Since 2005 initially, she was treated with MTX at a dose of 10mg/week orally that changed in 2014 to the injection route because of gastric intolerance. She also received oral corticosteroids (prednisone: 10mg/day). In January 2017, she had mucosal and cutaneous erosions, post-bullous affecting the face mostly cheeks and subciliary arches and the forearms. A cutaneous biopsy was performed and showed a histological appearance compatible with photo-aggravated toxiderma with an eroded epidermis, keratinocytic necrosis and the presence of numerous eosinophils in the dermis which is elastosic. The Direct Immunofluorescence study was negative. Based on clinical and histological data, the diagnosis of acute severe cutaneous MTX toxicity was suspected. The patient recovered following MTX withdrawal and using a cicatrizing cream after a duration of 5months. Treatment with Tocilizumab was started in March 2017. Conclusion: Although MTX is an option of great therapeutic value for RA. Rheumatologists and Dermatologists need to be alert to the possibility of cutaneous adverse events associated with MTX therapy.

A RARE CASE OF ANGIOLYMPHOID HYPERPLASIA WITH EOSINOPHILIA IN ORAL MUCOSA

The angiolymphoid hyperplasia with eosinophilia (ALHE) is considered a rare benign vascular lesion that mainly affects the skin and subcutaneous tissue of the head and neck, but is uncommon in the oral cavity. Its etiology remains unclear and it is described as a reactive vascular proliferation, vascular malformation, or neoplasia. Kimura’s disease is its main differential diagnosis. Here, we report a rare case of ALHE present on the lip of a 50-year-old male patient that exhibited size of approximately 3 cm with 7 years of evolution. After excisional biopsy, the histopathologic examination showed a well-encapsulated and multilobulated lesion with proliferation of blood capillaries that showed endothelial cells of epithelioid appearance, diffuse inflammatory infiltration with lymphocytes, plasma cells, numerous eosinophils, and presence of lymphoid follicles were also found. Immunohistochemical analysis revealed positivity for markers CD34, Bcl-2, and Ki-67 that, together with morphologic examination, support the diagnosis of ALHE.

Intranasal eosinophilic angiocentric fibrosis associated with an IgG4-related disease

Abstract Eosinophilic angiocentric fibrosis is an uncommon tumefactive lesion of the ocular orbit and upper respiratory tract. We present a 44-year old man with a history of severe nasal congestion and nasal obstruction. The patient also reported symptoms of sinusitis. Submucous thickening tissue had been locally resected and the involved anterior nasal septum cartilage partially removed. Histopathological examination of the biopsy indicated eosinophilic angiocentric fibrosis. A CT scan of the sinuses showed a high-density focal mass of soft tissue arising from the anterior aspect of the nasal septum. Examination under low power view showed dense concentric fibrosis and mixed inflammatory cells. The fibrosis was in an angiocentric pattern, resembling an onionskin. High power view showed a mixture of lymphocytes, plasma cells, numerous eosinophils, and proliferating fibroblasts. A test for serum IgG performed ten years after the patient's initial presentation was 1421 mg/dl (normal range 540–1822 mg/dl), and the serum concentration of IgG4 was 168.70 mg/dl (normal range 6.1–121 mg/dl). A review of the original hematoxylin and eosin-stained slides revealed that this case was stained immunohistochemically with an IgG4 stain showing 50 IgG4-positive plasma cells/HPF.

Composite Nasopharyngeal plasmacytoma with nodal paraimmunoblastic variant of small lymphocytic lymphoma: A case report.

A 78-year-old male who presented with severe shortness of breath and bilateral nasal congestion was shown to exhibit ta mass localized in the nasopharynx. The tumor was diagnosed as an extramedullary plasmacytoma. Peripheral blood eosinophilia had been persistently noted in the preceding 12 years. The plasmacytoma exhibited a predominance of κ-light chain monotypic Mott cells and was admixed with numerous eosinophils. No history of allergic rhinitis, asthma or aspirin sensitivity was elicited. An axillary lymph node was excised two weeks after the nasopharyngeal biopsy, and it exhibited a paraimmunoblastic transformation of small lymphocytic lymphoma. A review of the literature identified few occurrences of such simultaneous tumors in individual patients.

Recurrent feline gastrointestinal eosinophilic sclerosing fibroplasia and presumptive eosinophilic cystitis in a domestic short-haired cat: a case report

This report describes recurrent feline gastrointestinal eosinophilic sclerosing fibroplasia (FGESF) and eosinophilic cystitis in an 8-year-old domestic short-haired cat. The cat presented with incontinence, pollakiuria, vomiting and weight loss. An abdominal mass was palpated and ultrasonography revealed severe segmental thickening of the jejunal wall with loss of layering. Complete resection of the jejunal mass was performed. The resected mass was composed of branching trabeculae of dense collagen, intermixed with bundles of large fibroblasts and inflammatory cells, which is consistent with FGESF. One year later, a new mass reoccurred in another intestinal segment. Between both FGESF occurrences, mycoplasmas were cultured from urine and fine needle aspiration of the urinary bladder wall showed numerous eosinophils only; therefore, a presumptive diagnosis of eosinophilic cystitis was made. All haematological analyses performed within the one-year period revealed eosinophilia.

Flame figures in linear IgA bullous dermatosis: a novel histopathologic finding

Linear IgA bullous dermatosis (LABD) is an autoimmune subepidermal blistering disease usually with a neutrophil rich inflammatory infiltrate, and characterized by linear IgA deposition at the basement membrane zone (BMZ), and neutrophil predominant dermal inflammation. We report a case of LABD with numerous eosinophils and flame figure formation, a unique histopathologic finding not previously reported. A 69-year-old woman presented with a rapidly progressive, intensely pruritic rash over forearms, breasts, axillae, hips, and thighs. Thelesions were comprised of annular vesicles and bullae with hemorrhagic crusts and erosions. The clinical differential diagnosis included bullous pemphigoid(BP), LABD, and epidermolysis bullosa aquisita (EBA). A biopsy from a bullous plaque on the wrist revealed a subepidermal blister with neutrophils and numerous eosinophils with flame figure formation.Direct immunofluorescent (DIF) microscopy revealed linear deposition of IgA at the BMZ. Although unusual, the combined findings supported a diagnosis of LABD. Increased eosinophils may be associated with drug-induced LABD and may explain the numerous eosinophils in our case. It is important to be aware of this finding as the pathology may easily be misdiagnosed as BP, or possibly bullousWells syndrome. This case emphasizes that combined clinical, pathologic, and DIF findings are essential in the diagnosis of bullous dermatoses.

Eritema anular eosinofílico en un adulto Eosinophilic anular erythema in an adult

Eosinophilic annular erythema (EAE) is an uncommon eosinophilic dermatosis. Clinically it is characterized by recurrent episodes of annular or figurative plaques. The histopathological study shows a perivascular inflammatory infiltrate in the superficial and deep dermis, composed of lymphocytes and eosinophils. It was originally described in children. We report an adult woman who presented with recurrent erythematous annular plaques on the trunk and extremities. A biopsy showed a mainly perivascular lymphocytic infiltrate with numerous eosinophils in the dermis. Laboratory examinations revealed subclinical hypothyroidism. The lesions resolved with topical corticosteroid spontaneously after 3 months.

Histopathological Diagnosis of Fungal Sinusitis and Variety of its Etiologic Fungus

Fungal sinusitis is divided into two categories depending on mucosal invasion by fungus, i.e., invasive and noninvasive. Invasive fungal sinusitis is further divided into acute and chronic disease based on time course. Noninvasive fungal sinusitis includes chronic noninvasive sinusitis (fungal ball type) and allergic fungal sinusitis. Chronic noninvasive sinusitis is the most predominant fungal sinusitis in Japan, followed by allergic fungal sinusitis. Invasive fungal sinusitis is rare. Hyphal tissue invasion is seen in invasive fungal sinusitis. Acute invasive fungal sinusitis demonstrates hyphal vascular invasion while chronic invasive fungal sinusitis usually does not. Fungal tissue invasion is never found in noninvasive sinusitis. A fungal ball may exist adjacent to sinus mucosa, but its hyphae never invade the mucosa. Fungal balls sometimes contain conidial heads and calcium oxalate, which aid in identifying the fungus in the tissue. Allergic fungal sinusitis is characterized by allergic mucin that is admixed with numerous eosinophils and sparsely scattered fungal elements. Histopathology is important in classifying fungal sinusitis, especially in confirming tissue invasion by the fungus.