Remarkable Eosinophilia Research Articles

Een link tussen oedemen en eosinofilie: eosinofiele fasciitis

A link between oedema and eosinophils: eosinophilic fasciitis A 65-year-old man presented with progressive swelling in his 4 limbs. The skin on his limbs was oedematous and indurated, with an orange peel skin and blistering in some places, as well as a groove sign over the tibia. Lab results showed a remarkable eosinophilia of 23% (reference ≤ 6%). A deep skin biopsy revealed fascial infiltration and fibrin deposition, consistent with eosinophilic fasciitis (EF). EF is a rare cause of fasciitis, eosinophilia and polyclonal hypergammaglobulinemia. Because of its rarity, diagnostic delay is usually significant. Corticosteroids are the mainstay of therapy, but because of an incomplete response and the need for long-term treatment, corticosteroid sparing agents are often associated.

Clinico-radiologic Characteristics of Pulmonary Visceral Larva Migrans Caused by Ascaris suum.

Objective Visceral larva migrans (VLM) caused by Ascaris suum is a major health problem in pig farming regions. The clinical characteristics of pulmonary VLM caused by A. suum, however, are unclear. We assessed the clinico-radiologic features of this disease. Methods Medical records, including the results of chest radiography and high-resolution computed tomography (HRCT), were retrospectively reviewed from January 2000 through June 2019, at the University of Miyazaki Hospital and Kyoritsuiin Hospital in Miyazaki Prefecture, Japan. Results Seven patients with VLM caused by A. suum were identified. All seven patients had a unique habit of consuming raw foods, such as organic vegetables, chicken, turkey, wild boar, and venison. All but one patient, who had eosinophilic pneumonia with a fever and severe fatigue, had only mild or no respiratory symptoms. All 7 patients had remarkable eosinophilia (median, 1,960 /μL) and high serum IgE levels (median, 1,346 IU/mL). Chest HRCT revealed multiple nodules and multiple nodular ground-glass opacities in 57% and 29% of the patients, respectively. The pulmonary lesions were located predominantly in subpleural areas. All seven patients were treated with albendazole, which led to improvement within two to three months. Neither eggs nor parasites were detected in the feces or sputum of any patient. Conclusion Consumption of raw organic vegetables or raw meat is a possible route of A. suum infection. Infected patients exhibit mild respiratory symptoms, and multiple nodules with a halo in the subpleural area are a common finding on chest HRCT. Treatment with albendazole was effective in these cases.

Incidental Detection of Onchocerca Microfilariae in Donkeys (Equus asinus) in Italy: Report of Four Cases.

This paper reports the occurrence for the first time in Italy of autochthonous Onchocerca infection in donkeys. Four jennies, bred on the same farm, were referred to the Veterinary Teaching Hospital of Pisa for a check-up on ovarian activity (n = 3) or for veterinary support during the delivery (n = 1). Microfilariae were incidentally detected during the blood smear examination of one jenny. Peripheral blood samples were then collected from the other three jennies and the presence of microfilariae was investigated by Knott's test. Circulating unsheathed microfilariae were identified in all the animals. The level of microfilaraemia was between 1 and 31 microfilariae in 2 mL of blood. Hematological changes showed moderate eosinophilia in one case or both remarkable eosinophilia and basophilia in another case. Based on molecular findings by PCR and sequencing, the microfilariae showed 98% sequence similarity with Onchocerca sp. in the NCBI GenBank database (Accession No.: MK541848.1). The present report provides evidence that Onchocerca is an etiological agent of parasitic infection in donkeys in Italy. Our findings highlight the importance of screening in donkeys for Onchocerca even in the absence of clinical indications.

Eosinophilic peritonitis and nephrotic syndrome in Kimura\u2019s disease: a case report and literature review

BackgroundEosinophilic peritonitis is a relatively rare entity. Kimura’s disease is a rare chronic inflammatory disorder of unknown etiology, characterized by subcutaneous nodules mainly in the head and neck region, regional lymphadenopathy and occasional involvement of kidney. There is currently no report of eosinophilic peritonitis in Kimura’s disease.Case presentationA 44-year-old Chinese man presented with abdominal distention, nausea, vomiting and edema in lower limbs for 1 month. Laboratory data showed elevated eosinophils in peripheral blood and ascites, nephrotic syndrome with progressively renal dysfunction, and elevated IgE. Ultrasonography of lymph nodes showed multiple lymphadenopathy in bilateral inguinal regions. Surgical excision was performed for one of the enlarged lymph nodes and histopathology revealed diagnosis of Kimura’s disease. Renal biopsy indicated focal segmental glomerulosclerosis (FSGS) and acute tubulointerstitial nephritis with infiltration of eosinophils in renal interstitium. The patient was prescribed with oral prednisolone therapy (30 mg/day), and underwent continuous ambulatory peritoneal dialysis (CAPD). The peripheral and peritoneal eosinophil count decreased rapidly and normalized within 2 days. Forty-five days after prednisolone therapy, partial remission of nephrotic syndrome and decrease of serum creatinine were achieved while peritoneal dialysis dosage had decreased. Inguinal lymph nodes gradually shrunk in size. The overall conditions remain stable afterwards.ConclusionsThis rare case highlighted the clinical conundrum of a patient presenting with eosinophilic peritonitis, lymphadenopathy, nephrotic syndrome and renal failure associated with Kimura’s disease. The remarkable eosinophilia, pathology of lymph node and kidney, as well as significant response to steroids should guide towards the diagnosis.

Kimura’s disease or IgG4-related disease? A case-based review

Kimura's disease usually presents with benign painless soft tissue swelling around the head and neck areas with eosinophilia and high immunoglobulin E (IgE) levels. IgG4-related disease is characterized by fibrosis and sclerosis of the involved organs, with infiltration of IgG4-positive plasma cells. There are some similar clinical manifestations of these two diseases, with eosinophilia or high IgE levels often found in patients with IgG4-related disease. However, the relation between these two diseases is not well known. We report a 23-year-old man who had multiple neck lumps for longer than 1 year. He had remarkable eosinophilia and elevated serum IgE levels. Biopsy of his lymph nodes suggested the diagnosis of both Kimura's disease and IgG4-related disease. In this article, we discuss the relationship between Kimura's disease and IgG4-related disease. We also suggest a possible model ("allergen-specific immunotherapy") to illustrate our view that an increase in IgG4-positive plasma cells is an epiphenomenon of Kimura's disease.

Hypereosinophilic syndrome induced cystitis mimicking bladder tumor

Hypereosinophilic syndrome induced cystitis mimicking bladder tumor

A Case of Incontinentia Pigmenti with Remarkable Eosinophilia and Convulsive Disorder

A Case of Incontinentia Pigmenti with Remarkable Eosinophilia and Convulsive Disorder

A Case of Recurrent Bowel Perforation in a Patient with Churg-Strauss Syndrome

Churg-Strauss syndrome is a rare systemic disorder characterized by asthma, eosionphilia and necrotizing vasculitis affecting small-to-medium-sized vessels. Although it is frequently associated with gastrointestinal mucosal lesions, recurrent bowel perforation is rare and potentially life threatening. We report a case of a 66-year-old man with Churg-Strauss syndrome, who pre- sented with recurrent small bowel perforation. He was admitted with abdominal pain developed previous night, who had a previous small bowel perforation history treated with laparoscopic closure 5 months ago. Laboratory data showed remarkable eosinophilia. Physical examination indicated positive signs of peritoneal irritation in the entire abdomen, and abdominal computed tomography scanning showed edematous small bowel with intra-abdominal free air, suggesting intestinal perforation. He underwent laparoscopic small bowel closure and was treated with steroid.

An aggressive and lethal course of Churg–Strauss syndrome with alveolar hemorrhage, intestinal perforation, cardiac failure and peripheral neuropathy

Churg-Strauss syndrome (CSS) is a rare type of necrotizing vasculitis affecting small to medium-sized vessels typically characterized by asthma, lung infiltrates, necrotizing granulomas and hypereosinophilia. Herein, we describe a case of CSS presenting severe and aggressive course. A 35-year-old male patient with weight loss, dyspepsia, dyspnea and hemoptysis was admitted. The laboratory analyses indicated a remarkable eosinophilia, elevated levels of serum total IgE and positive cANCA. Thorax CT findings were suggestive of alveolar hemorrhage. Bronchoalveolar lavage revealed alveolar hemorrhage with eosinophilia and transbronchial lung biopsy showed eosinophilic vasculitis. Cardiac enzymes were increased and murmurs were audible revealing cardiomyopathy proven by echocardiography. Pulse cyclophosphamide and methyl prednisolone was immediately started. On the 21st day, intestinal perforation developed and urgent surgery was performed. During a follow-up, although a radiological improvement was observed in the chest X-ray, cardiac failure, peripheral neuropathy and skin lesions developed and high-dose intravenous immunoglobulin and anti-TNF therapy (adalimumab) were applied. Despite the therapy, he died from heart failure and septicemia at 68th day of therapy.

凝固・線溶・キニン系の変動を呈した好酸球増多症の2例

凝固・線溶・キニン系の変動を呈した好酸球増多症の2例

Isolated Optic Neuritis from an Identified Gnathostoma Spinigerum

To describe a patient with isolated monocular optic neuritis caused by an identified Gnathostoma spinigerum infestation. A 21-year-old man developed a swollen eyelid and painful monocular visual loss of his left eye which did not improve after treatment by intravenous steroid and albendazole. A remarkable eosinophilia in his peripheral blood count was demonstrated. The patient subsequently found a live parasite emerged from his lower eyelid and it was successfully removed by himself. Gross and histopathology examinations of the obtained parasite was undertaken. The parasite was identified as Gnathostoma spinigerum. His blood test for Gnathostoma antibody was positive. The etiology of isolated optic neuritis in this patient was Gnathostoma spinigerum which was confirmed by the histopathology of the obtained parasite and the positive serologic test. We could identify the exact parasite that was proven to cause an isolated optic neuritis. The immediate removal of a causative parasite maynot result in an improvement of the injured tissue but is beneficial in preventing further destruction as well as future complications.

Idiopathic Acute Eosinophilic Pneumonia

Idiopathic acute eosinophilic pneumonia (IAEP) is a rare disease but of clinical importance because of its good prognosis if treated promptly and appropriately. The etiology remains unknown and the temporal relationship between IAEP and a history of resent onset of cigarette smoking has been described. We report a typical case of a 21-year-old male with recent onset of smoking, who presented with acute febrile hypoxemic respiratory failure. High-resolution chest computed tomography scan revealed patchy ground glass opacity and ill-defined nodules, diffuse interlobar and interlobular septal thickening, and bilateral small amount of pleural effusion, which mimicked congestive heart failure except that the heart size was within normal limits. Bronchoalveolar lavage (BAL) was performed soon after the patient was admitted and remarkable eosinophilia was noted in BAL fluid. Clinical condition and chest radiographs improved dramatically after corticosteroid treatment. Because effective treatment and prompt institution of therapy can obviate unnecessary morbidity and mortality, IAEP should be kept in mind when treating patients presenting with diffuse parenchymal lung disease and acute respiratory failure. In that case, BAL is valuable and should be performed as soon as possible.

Churg-Strauss syndrome complicated by colon erosion, acalculous cholecystitis and liver abscesses.

We report on a case of Churg-Strauss syndrome (CSS) with colon erosion, cholecystitis and liver abscesses. A 21-year-old woman with a history of bronchial asthma for 3 years was admitted with a complaint of abdominal pain. Laboratory findings included remarkable leukocytosis and eosinophilia, and a colonoscopy revealed erosion from the rectum to the ileocecal region. In addition, a colonic biopsy specimen showed necrotizing vasculitis and marked eosinophilic infiltration. On the basis of the clinical features and histopathological findings, she was diagnosed with CSS and subsequently treated with oral prednisolone, after which the eosinophilia and abdominal pain disappeared. However, on the 15th d in hospital she developed cholecystitis and liver abscesses. She was therefore treated with antibiotics and as a result went into clinical remission.

Valores hematológicos e identificação morfo-citoquímica de células sangüíneas de capivaras (Hydrochoerus hydrochoeris) parasitadas por carrapatos e capivaras livres de infestação

Blood samples were collected from thirty seven adult parasited capybaras and twenty one free of parasitism aiming the characterization of different circulating cell types and complete hemogram. After a morphological analysis, the blood cells were identified as heterophils, eosinophils, basophils, lymphocytes, monocytes and platelets. The PAS reaction revealed glycogen in heterophils and platelets cytoplasm. A positive reaction was found only in heterophils round granules and in all cytoplasmic granules of eosinophils for the demonstration of myeloperoxidase activity and lipids. The bromofenol blue method revealed strong positivity in heterophils, eosinophils, basophils granules and red blood cells. A positive reaction for alkaline phosphatase was observed in eosinophils and heterophils. The blood parameters studied showed statistic differences (p 6 /µL and 2,81±0,62 x 10 6 /µL) , haematocrit (48.14±4.75% and 41,22±6.21%) and heterophils (39,38±11,02% and 16,14±7,13%) /eosinophils (8,57±3,78% and 21,92±10,24%) in differential count. In this case the ticks involved in the parasitism of these capybaras were identified as Amblyomma cajenense and Amblyomma cooperi . These data showed that the highly infested capybaras presented some anemia and a remarkable eosinophilia.

Spontaneous B-cell IgE production in a patient with remarkable eosinophilia and hyper IgE

The pathophysiology of eosinophilia and hyper-IgE is not fully elucidated yet. To clarify the pathophysiology of a patient with remarkable eosinophilia and hyper IgE, we examined cytokine levels in serum, surface antigens of peripheral blood eosinophils and IgE production in vitro. Concentrations of tumor necrosis factor-alpha (TNF-alpha), interleukin-3 (IL-3), interleukin-4 (IL-4), interleukin-5 (IL-5), and granulocyte/macrophage-colony stimulating factor (GM-CSF) in the serum were 21 pg/mL, <15 pg/mL, <15 pg/mL, 8 pg/mL, and <5 pg/mL pg/mL, respectively. Newly expressed surface antigens CD4, CD25, CD69, and HLA-DR, but not CD54, were observed on peripheral blood eosinophils. Extremely high levels of IgE secretion was found in the patient's mononuclear cells without stimuli; this was not enhanced by IL-4 or IL-4 plus anti-CD40 monoclonal antibody stimulation. Furthermore, highly purified B cells spontaneously produced large amounts of IgE and the production was not enhanced in addition of his T cells. The eosinophils were activated, and the B cells spontaneously produced IgE independently of T cells or cytokines, suggesting that intrinsic abnormality of B cells leading to dysregulated production of IgE in this disease.

Systemic Necrotizing Vasculitis with Renal Involvement Accompanied by Remarkable Eosinophilia: A Case with Overlapping Features of Polyarteritis Nodosa and Allergic Granulomatous Angiitis.

A 71-year-old woman was clinically suspected of allergic granulomatous angiitis (AGA) because of preceding allergic diseases including bronchial asthma, remarkable eosinophilia (14,300/mm3), mononeuritis multiplex, positive rheumatoid factor, elevated serum immunoglobulin E, and eosinophilic inflammation of the kidney. Autopsy findings, however, were characterized of polyarteritis nodosa (PAN). Necrotizing angiitis was present in several organs except for the lung; focal and segmental glomerular lesions with crescent formation were observed in the kidney, and granuloma formation was not found. This case may be an intermediate type between PAN and AGA (an overlap syndrome) and provide useful information on the clinical entities of systemic necrotizing vasculitis.

Basophilia Observed as the Result of Daily Routine Hematological Work

1. In 30 healthy boys and girls, basophiles showed 0-1.0% (43 per cram. in absolute number, on an average). 2. In 82% out of all 279 cases, basophiles were below 200, and in 93% below 300. 3. Eosinophilia (over 260) was seen in 60.6% (169 cases) and remarkable eosinophilia (over 300) in 53.8% (150 cases). 4. Basophilia and eosinophilia do not always run parallel in in-tensity to each other.