Presence Of Eosinophilic Infiltration Research Articles

Eosinophilic gastrointestinal disorders in childhood

Eosinophilic gastrointestinal disorders are a group of chronic inflammatory conditions characterised by the presence of eosinophilic infiltrates in the gastrointestinal wall. These disorders include eosinophilic esophagitis, eosinophilic gastritis, eosinophilic gastroenteritis, eosinophilic enteritis, and eosinophilic colitis. Their incidence is increasing, with eosinophilic esophagitis known to be the most common form. The etiopathogenesis of eosinophilic gastrointestinal disorders is not fully understood, and most likely associated with an abnormal immune response to food and/or inhalant allergen. They are often accompanied by allergies. Clinical symptoms, especially in the youngest children, are non-specific and depend on the gastrointestinal segment involved. These are most often feeding difficulties and regurgitation in infants, and heartburn, chest pain, dysphagia and food bite impaction in adolescents and adults. Except for eosinophilic esophagitis, there are no uniform diagnostic or therapeutic guidelines for eosinophilic gastrointestinal disorders. Diagnosis is challenging and it is based on the coexistence of clinical, endoscopic and histopathological symptoms and the exclusion of secondary causes of gastrointestinal eosinophilic infiltration. Treatment involves the use of proton pump inhibitors, an elimination diet, or glucocorticoid therapy. Endoscopic or surgical treatment may be necessary in some cases. Clinical remission does not correlate with histopathological remission, therefore monitoring of therapeutic effects requires multiple endoscopies with histopathological assessment of specimens. The aim of this paper was to present the current data on the incidence, diagnosis and treatment of eosinophilic gastrointestinal diseases in children.

Canine eosinophilic bronchopneumopathy: case study

Eosinophilic bronchopneumopathy, formerly known as PIE (Pulmonary Infiltration with Eosinophils) syn¬drome, is defined as an inflammatory pathology haracterized by the presence of eosinophilic infiltrate in the lungs and bronchiolary structures. (CECILE CLERCX,2007). Canine eosinophilic bronchopneumopathy has been described similarly to that present in humans, highlighting tropism for the airways and lungs, but also the multitude of factors with the potential to trigger, which is why most of them are ranked with idiopathic factor. (Sol Kim et a1,2021). Cases of eosinophilic bronchopneumopathy have been identified in most canine breeds, and according to current studies, the predisposition for large breeds under the age of 6, such as rottweilers, Siberian Husky and Alaskan Malamute, has been reported. (C. Clercx 2017). The present case is represented by a male, canine, of the Husky breed, who showed clinical respiratory signs, these were correlated with complementary examinations such as laboratory examinations, cardiological examination, radiological and endoscopic examination. Based on the haematological results, which present a marked eosinophilia, a dif¬ferentiated diagnostic protocol was achieved compared to possible parasitosis and reactions of autoimmune type. Differential clinical diagnosis was made against dirofilariosis, angiostrongiliosis, lupus erythematosus, mycotic pneumopathies. PCR technique was used to determine the possible parasites present, sample collec¬tion with the help of endoscopy from the pulmonary infiltrate with cytological examination. The diagnosis of certainty was established on the basis of histopathological examination. He underwent treatment with cortico¬steroids, the evolution being favorable within 14 days of initialization of the treatment, with complete healing.

Wells’ syndrome associated with eosinophilic granulomatosis with polyangiitis − A case report

Introduction. Wells` syndrome (eosinophilic cellulitis) is a chronic, recurrent disease characterized by episodes of erythematous and edematous plaques or nodules with occasional development of hemorrhagic bullae on the trunk and limbs. Eosinophilic granulomatosis with polyangiitis, formerly known as Churg-Strauss syndrome, is a specific variant of the group of diseases characterized by necrotizing vasculitis of small to medium-sized blood vessels affecting multiple organ systems. The association of Wells` syndrome and eosinophilic granulomatosis with polyangiitis is very rare, and to our knowledge has been reported in only ten patients. Case report. We present a case of a 34-year-old woman with a 3-year history of periodical onset of erythematous plaques on the trunk and edematous plaques clinically resembling cellulitis on her lower limbs. The patient reported a one-year history of asthma, rhinosinusitis, and nasal polyposis. Skin biopsy revealed the presence of diffuse eosinophilic infiltrates in the dermis accompanied by characteristic ?flame figures?. Further investigation showed peripheral blood eo-sinophilia (22.6%), bilateral maxillary sinusitis, presence of eosinophil infiltrates and microabscesses in the bron-chial wall, and pericapillary eosinophil infiltrates in the pulmonary interstitium shown by bronchoscopy and transbronchial biopsy, respectively. Treatment was started with methylprednisolone 0.5 mg/kg/day, and the dose was gradually tapered for the following twelve weeks. Complete remission of skin changes was achieved, but new lesions appeared in the past two years, which required repeated treatment. Conclusion. Association of these syndromes is unusual and may be based on the common pathogenetic background. We hypothesize that Wells` syndrome could be a stage preceding eosinophilic granulomatosis with polyangiitis, and that patients should be evaluated for eosinophilic granulomatosis with polyangiitis, since these two diseases overlap in clinical and laboratory findings.

Role of galectins 1 and 3 in the recruitment of eosinophilic granulocytes into tumor tissue in gastric and colon cancers

Background: Gastric and colon tumors are often associated with eosinophilic infiltration of tumor tissue, the significance of which is still not entirely clear. The recruitment of eosinophils into the tissues can be in part regulated by galectins ― galactose-binding proteins which are expressed by a variety of tissues and are capable of exerting a broad range of effects.
 Aims: To evaluate the expression of galectin-1 and galectin-3 in tumor tissue, and gal-3 gene mRNA expression in blood eosinophils in patients with gastric and colon cancer with or without tissue eosinophilia.
 Materials and methods: The study included a total of 107 patients (84 males and 23 females, average age 60,9 6,8) with verified gastric cancer (52 persons) and colon cancer (55 persons), who underwent treatment or were registered at the dispensary at the regional medical institution Tomsk Regional Oncology Center (Tomsk, Russia). The control group consisted of 15 men and 11 women of comparable age. The materials of the research included samples of gastric and colon tumors obtained during surgery, and eosinophilic granulocytes isolated from whole blood by immunomagnetic separation. Galectin-1 and galectin-3 expression in tumor tissue was evaluated by immunohistochemistry. The expression of gal-3 gene mRNA in eosinophils was determined by real-time reverse transcription polymerase chain reaction. Statistical analysis of the results was carried out using the non-parametric Mann-Whitney U test for independent samples with Benjamini-Hochberg procedure for multiple comparisons, and the Chi-square Pearson criterion with Yates correction.
 Results: In patients with gastric cancer and colon cancer, regardless of the presence of tissue eosinophilia, low expression of galectin-3 in the tumor tissue and high expression of gal-3 gene mRNA in peripheral blood eosinophils were found. Gastric and colon cancer patients with eosinophilic infiltration of tumor tissue were characterized by low expression of galectin-1 within tumor cells (in 64.0% cases, 2 = 4.890, р = 0.029; and in 73.9% cases, 2 = 5.981, p = 0.031 respectively). There was a statistically significant connection between the level of galectin-1 expression by tumor cells and the presence of tissue eosinophilia both in gastric ( = 0.307) and colon cancer ( = 0.330).
 Conclusion: Low expression of galectin 1 and 3 by tumor cells in gastric and colon cancer with tissue eosinophilia indicates the lack of a significant effect of these proteins on the process of recruiting eosinophilic granulocytes into tumor tissue. Increased expression of galectin-3 in blood eosinophils in gastric and colon cancer is not associated with the presence of eosinophilic infiltration of tumor tissue.

788 The Natural History and Treatment Outcomes of Concomitant Eosinophilic Esophagitis (EoE) and Inflammatory Bowel Disease (IBD)

INTRODUCTION: Eosinophilic esophagitis (EoE) and inflammatory bowel disease (IBD) are distinct chronic inflammatory conditions involving the gastrointestinal tract. The presence of eosinophilic infiltration in gastrointestinal mucosa has been observed as a histopathological feature of IBD, being described in both Crohn's disease (CD) and ulcerative colitis (UC). The natural history of patients with coexisting EoE and IBD has not been extensively studied. Our aim was to determine clinical characteristics and treatment outcomes in patients with concomitant IBD and EoE. METHODS: A retrospective cohort study was performed of all EoE patients who also had a diagnosis of IBD from January 2000 to December 2018. Patients were identified using ICD-9 and ICD-10 diagnostic codes. Confirmation of EoE and IBD diagnoses were required for inclusion in the study. Pertinent demographic and clinical data were extracted from the electronic medical record. Treatment outcomes and frequencies of disease-related complications were determined. RESULTS: Sixty-nine patients met inclusion criteria (68.1% male) with a median follow-up of 6 years. Forty-one patients had a diagnosis of CD (59.4%), 26 UC (37.7%), and 2 indeterminate colitis (IC) (2.9%). Forty-eight patients were diagnosed with IBD prior to EoE (69.6%). The most common treatments for EoE were proton pump inhibitors (78.3%) and topical steroids (59.4%) with 51.9% and 63.4% demonstrating clinical improvement, respectively (Table 1). The most common treatments for IBD were oral 5-aminosalicyclic acid (5-ASA) (69.6%), oral corticosteroids (66.7%), azathioprine (44.9%), and adalimumab (43.5%), with 37.5%, 43.5%, 35.5%, and 50% demonstrating clinical improvement, respectively (Table 2). Fifteen patients with CD (36.5%), 7 with UC (26.9%) and 1 with IC (50%) required surgical intervention for IBD. Eighteen patients with CD (43.9%), 8 with UC (30.8%), and 1 with IC (50%) required hospitalization for IBD (Table 3). CONCLUSION: Recent literature has shown an association between IBD and EoE. In our cohort, IBD is the more frequent initial diagnosis. As such, it is important to be vigilant for signs suggestive of EoE in patients with IBD and evaluate accordingly. It seems most patients with IBD and EoE respond to conventional treatment modalities used for each diagnosis. However, about 40% of patients with CD and EoE required hospitalization and/or surgical intervention, possibly suggesting a more severe phenotype in this specific subset of patients.

Eosinophilic cholangitis is a potentially underdiagnosed etiology in indeterminate biliary stricture.

AIMTo investigate presence and extent of eosinophilic cholangitis (EC) as well as IgG4-related disease in patients with indeterminate biliary stricture (IBS).METHODSAll patients with diagnosis of sclerosing cholangitis (SC) and histopathological samples such as biopsies or surgical specimens at University Hospital Frankfurt from 2005-2015 were included. Histopathological diagnoses as well as further clinical course were reviewed. Tissue samples of patients without definite diagnosis after complete diagnostic work-up were reviewed regarding presence of eosinophilic infiltration and IgG4 positive plasma cells. Eosinophilic infiltration was as well assessed in a control group of liver transplant donors and patients with primary sclerosing cholangitis.RESULTSone hundred and thirty-five patients with SC were included. In 10/135 (13.5%) patients, no potential cause of IBS could be identified after complete diagnostic work-up and further clinical course. After histopathological review, a post-hoc diagnosis of EC was established in three patients resulting in a prevalence of 2.2% (3/135) of all patients with SC as well as 30% (3/10) of patients, where no cause of IBS was identified. 2/3 patients with post-hoc diagnosis of EC underwent surgical resection with suspicion for malignancy. Diagnosis of IgG4-related cholangitis was observed in 7/135 patients (5.1%), whereas 3 cases were discovered in post-hoc analysis. 6/7 cases with IgG4-related cholangitis (85.7%) presented with eosinophilic infiltration in addition to IgG4 positive plasma cells. There was no patient with eosinophilic infiltration in the control group of liver transplant donors (n = 27) and patients with primary sclerosing cholangitis (n = 14).CONCLUSIONEC is an underdiagnosed benign etiology of SC and IBS, which has to be considered in differential diagnosis of IBS.

DESCRIPCIÓN ANATOMOPATOLÓGICA DE LESIONES POR HELMINTOS GASTROINTESTINALES EN TORTUGAS MOTELO (Chelonoidis denticulata)

The present aimed to identify and describe lesions caused by helminths in motelo tortoises(Chelonoidis denticulata). Forty gastrointestinal tracts were collected at Belen market inIquitos, Peru where this species is sold for meat consumption. The macroscopic analysisshowed that 42.5, 70.0, and 100% of the stomachs, small intestine and large intestinerespectively were parasitizedor affected by pathological –possibly due to parasites–changes like nodules, blackish coloration areas, ulcers, perforations, thickening,congestion and hemorrhagic areas. Parasites of 11 species were collected: Labidurisgulosa, Labiduris zschokkei, Labiduris irineuta, Atractis marquezi, Klossinemellatravassosi, Sauricola sauricola, Chapiniella variabilis, Angusticaecum holopterumand Ophidascaris arndti (Nematoda), and Halltrema avitellina and Helicotrema spirale(Trematoda). Histologically, an invasion of the four gastrointestinal layers by parasiticstructures compatible with H. avitellina (and its eggs), C. variabilis, S. sauricola and unundetermined species of atractideus was observed mostly surrounded by inflammatoryexudates formed by eosinophiles, giant cells, lymphocytes and connective tissue. Also,the presence of eosinophilic infiltrate in the mucosa was found as a response to thecontact with O. arndti and H. spirale. The results showed that all animals presentedparasitic lesions in the large intestine, most of them severe; whereas lesions in stomachand small intestine were mainly moderate and mild.

Eosinophilic gastroenteritis: A case report with review of the literature

Eosinophilic gastroenteritis (EG) is a heterogenous disorder affecting adults, and is characterized by the presence of eosinophilic infiltration in the gastrointestinal tract. The clinical features of EG are related to the layers and extent of bowel involved from the esophagus to the colon. The diagnosis is typically confirmed by biopsy, which should reveal 20-25 eosinophils per high-power field on microscopic examination. We report a 38-year-old man who presented with a 2-month history of dyspeptic symptoms. On examination, he was found to have only moderate ascites. The investigations revealed peripheral eosinophilia with markedly elevated eosinophils (95%) in the ascitic fluid. The imaging studies showed diffuse concentric bowel wall thickening involving the entire small bowel. The diagnosis was confirmed by biopsy from the antrum of the stomach. The patient was managed with steroids.

Impact of cow’s milk allergy on enterocolitis associated with Hirschsprung’s disease

To investigate the impact of cow's milk allergy (CMA) on infants with Hirschsprung's disease (HD). Twenty-four patients, who developed gastrointestinal symptoms before the age of 60 days and underwent surgery for HD in the period between January 2003 and December 2012, were enrolled in this study. They were divided into two groups based on CMA-related findings: stimulation index of lymphocyte stimulation test >300 % and the presence of eosinophilic infiltration in the resected colon. Ten patients were determined specimen as not having CMA (Group A), because they did not satisfy any of the criteria. The remaining 14 were determined as having possible CMA (Group B), because they satisfied either or both findings. Patient background characteristics, pre- and postoperative clinical history, and laboratory data were compared between Groups A and B. Pre- and postoperative enterocolitis did not occur in Group A patients. Postoperative enterocolitis was more frequent in Group B than in Group A (p = 0.04). Other clinical and laboratory data did not show significant difference between the two groups. CMA is a possible risk factor for postoperative enterocolitis in patients with HD.

Cardiac markers: profile in rats experimentally infected with Toxocara canis

The aim of this study was to evaluate the profile of the enzymes creatine kinase (CK), creatine kinase MB (CK-MB) and lactate dehydrogenase (LDH) in Wistar rats infected with 250 (GI, n = 24) or 1000 (GII, n = 24) Toxocara canis eggs. Animals were evaluated on days 7, 15, 30, 60, 120 and 180 post-infection (DPI). Only the GI rats showed an increase in CK and CK-MB, at 15 and 30 DPI, respectively. Anti-Toxocara spp. antibodies were detected by ELISA in infected animals. Despite of the presence of eosinophilic infiltrate in the heart of three infected animals, none larva was recovered from the organ neither by acid digestion nor by Baermann procedure. Eosinophilia was observed in both groups but there was no significant difference in the eosinophil counts between GI and GII (p = 0.2239). It is possible to consider that cardiac lesion is an eventual finding in murine model for toxocariasis.

Churg-Strauss Syndrome Presenting with Acute Renal Insufficiency Accompanied by Eosinophilic Tubulointerstitial Nephritis

We encountered an unusual and rare case of 59-year-old woman with Churg-Strauss syndrome (CSS) showing myeloperoxidase anti-neutrophil cytoplasmic antibody (MPO-ANCA)-related acute renal insufficiency accompanied by eosinophilic tubulointerstitial nephritis. To date, reports in English of CSS presenting with rapidly progressive/acute renal insufficiency and biopsy-proven renal lesions have been uncommon. Here, we discuss this unusual case and review the previously reported CSS cases. The complication of eosinophilic tubulointerstitial nephritis in CSS cases with acute renal insufficiency might be higher than generally thought. Furthermore, the presence of eosinophilic infiltration and eosinophilic tubulointerstitial nephritis might be associated with the good renal outcome in CSS patients.

Concomitant occurrence of acneiform eruption, alopecia areata, and urticaria during adalimumab treatment in a patient with pustulosis palmoplantaris: Case report and literature review

Abstract Adalimumab is a fully human immunoglobulin G1 monoclonal antibody against tumor necrosis factor (TNF)-α that is increasingly used for the treatment of many autoimmune diseases. However, it has also been reported that adalimumab can induce many adverse cutaneous reactions, including paradoxical psoriasiform eruptions. We describe a patient with pustulosis palmoplantaris who developed four cutaneous adverse reactions, including eczematous lesions, acneiform eruption, alopecia areata, and urticaria during adalimumab treatment. A common histopathological finding in these acneiform and urticarial lesions was the presence of eosinophilic infiltrates. Some authors assume that cross-regulation between TNF-α and interferon-α may contribute to development of a clinical spectrum of cutaneous reactions in predisposed individuals undergoing anti-TNF therapy. The use of different biologics, including adalimumab, etanercept, and ustekinumab, did not seem to improve pustulosis palmoplantaris disease activity in our patient.

Betametasona e extrato aquoso de Arctium lappa no tratamento da angiostrongilíase

Angiostrongylus costaricensis is a parasite that causes abdominal angiostrongyliasis in humans. The treatment for it includes the use of anti-inflammatory drugs, despite the lack of studies to justify this approach. The objective of this paper was to evaluate the effect of betamethasone and Arctium lappa on the evolution of intestinal lesions induced by this parasite. Adult male Swiss mice were used, distributed into four groups: infected and treated with betamethasone; infected and treated with Arctium lappa; infected and not treated; and control group. The treatments were started on the 15th day after infection and continued for 15 days. The presence of eosinophilic infiltration and granuloma was evaluated (1-mild; 2-moderate; 3-severe). Betamethasone allowed the lesions to evolve into more severe forms, while the extract did not interfere with disease progression. The substances applied were ineffective for protection against the lesions induced by Angiostrongylus costaricensis in mice. These findings discourage the use of betamethasone and Arctium lappa for humans affected by abdominal angiostrongyliasis.

Liver eosinophilic infiltrate is a significant finding in patients with chronic hepatitis C

Eosinophilic infiltrate of liver tissue is described in primary cholestatic diseases, hepatic allograft rejection and drug-induced liver injury, but its significance and its implications in chronic hepatitis C are unknown. The aim of this study was to investigate the clinical significance of eosinophilic liver infiltrate in patients with chronic hepatitis C. We retrospectively evaluated 147 patients with chronic hepatitis C. The presence of eosinophilic infiltrate was investigated in liver biopsies, and a numeric count of eosinophilic leucocytes in every portal tract was assessed. An eosinophilic infiltrate of liver tissue (> or =3 cells evaluated in the portal / periportal spaces) was observed in 46 patients (31%), and patients who consumed drugs had an odds ratio (OR) of 4.02 (95% CI: 1.62-9.96) to have an eosinophilic infiltrate in liver biopsy. By logistic regression analysis, the presence of steatosis was independently associated with eosinophilic infiltrate (OR 5.86; 95% CI: 2.46-13.96) and homeostasis model assessment-score (OR 1.18; 95% CI: 1.00-1.39). Logistic regression analysis also showed that fibrosis staging > or = 2 by Scheuer score was associated with grading >1 by Scheuer score (OR 6.82; 95% CI 2.46-18.80) and eosinophilic infiltrate (OR 4.00; 95% CI 1.23-12.91). In conclusion, we observed that the eosinophilic infiltrate of liver tissue was significantly more frequent in patients who assumed drugs, and found a significant association between eosinophilic infiltrate, liver steatosis and liver fibrosis. These preliminary data could lead to a constant assumption of drugs as a co-factor of eosinophils-mediated liver injury in chronic hepatitis C.

Brachial artery occlusion secondary to hypereosinophilic syndrome

Hypereosinophilic syndrome (HES) is characterized by an overproduction of eosinophils that leads to organ damage. Although most cases of HES frequently affect the lungs, heart, and gastrointestinal tract, there are a few reported cases of peripheral vascular involvement. We report a case of a patient with a history of colonic HES who presented with idiopathic occlusion of the brachial artery. A 28-year-old woman with a recent history of eosinophilic colitis presented with a several-week history of left hand pain, pallor, and paresthesias. Her hand was cool, without palpable pulses. Her eosinophilia count was 38%. An arteriogram documented a left brachial artery occlusion and diffuse left arm vasospasm. A brachial-to-brachial bypass was performed. Postoperatively, there was extensive vasospasm of her distal upper extremity arteries, which was treated with calcium-channel blockers and steroids. Her symptoms resolved and she has been asymptomatic for 9 months. The segment of occluded artery was found to contain many eosinophils on histologic examination. HES of the arterial system is an exceedingly rare cause of occlusion. Our patient presented with eosinophilia, arterial vasospasm with subsequent occlusion, and the presence of eosinophilic infiltration on the pathologic specimen. These data, combined with the patient's previous history, demonstrate that the patient's occlusion may have been secondary to HES.