Unexplained Eosinophilia Research Articles

Eosinophilia, increased IgE and toxocariasis in children

Fifteen children with persistent unexplained eosinophilia were investigated of which 4 cases with one or more symptoms of cough, wheezing, pulmonary infiltration, recurrent pneumonia, skin rash, abdominal discomfort and pain, diarrhoea and hepatosplenomegaly were confirmed to be due to toxocara infection. Raised serum IgE was detected in 3 cases and its significance is discussed. It was concluded that toxocariasis causing eosinophilia in children is not uncommon and increased serum IgE may be a useful finding for the diagnosis of visceral larva migrans.

Hepatic coma associated with methoxyflurane anesthesia. Report of a case.

This report describes a patient who developed hepatic coma following methoxy-flurane anesthesia and recovered following exchange transfusion. The difficulties delineating the true hepatotoxin in this setting are discussed, but it is considered likely that methoxyflurane was responsible. A review of past experience with this agent and analogous halogenated hydrocarbon anesthetics strongly suggests an association with hepatic dysfunction. Until this relationship is disproven, we feel that this anesthetic should not be used as an agent of first choice in patients with a history of unexplained postoperative fever, rash or eosinophilia. The risk to operating-room personnel, who may have been inadvertently sensitized, must be considered.

Acanthocheilonema perstans, a cause of significant eosinophilia in the tropics: comments on its pathogenicity.

48 patients with proved A. perstans infection, but without other significant helminthic infection or other detectable cause of eosinophilia, were studied. 69% had eosinophilia, and 48% eosinophilia of more than 1,000 per c.mm. The possibility of other helminthic infection, particularly with occult human or animal filariae, as a cause of the eosinophilia is discussed but it was thought on clinical, haemotological and therapeutic grounds that they were not responsible. Infection with A. perstans is probably an important cause of much unexplained eosinophilia in the tropics. Hypereosinophilia, defined as an eosinophil count of above 3,000 per c.mm., was found in 6 of 48 patients, and the case history of one of these is presented. Signs and symptoms thought to be associated with A. perstans infection were found in 77%, and those most frequently seen (pruritus or rash, transient swellings, and pain in the liver region) are discussed. Analysis of the results suggested that the higher the eosinophilia the more likely were symptoms to be present, but the numbers were too small for statistical significance. There was no correlation between the presence or absence of symptoms and the result of the filarial complement fixation test. The filarial complement fixation test was positive in 32% of 37 patients and analysis showed that it was more likely to be positive if eosinophilia was present. No significant difference as regards eosinophil level, symptomatology or result of the filarial complement fixation test was found between patients of African origin and those of European origin.

An Unexplained Eosinophilia in the Medulla of the Adrenal of Sheep

An Unexplained Eosinophilia in the Medulla of the Adrenal of Sheep

Abnormalities in the secretion of the adrenal cortex during early life

Summary This paper deals with the clinical, chemical, and pathologic findings of seven children who presented abnormalities in secretion of the adrenal cortex. All cases, save one, were congenital in origin. Five of these patients presented the picture of insufficiency of the substances regulating salt and water metabolism. In each of them the most prominent symptoms were dehydration with poor gain of weight and/or vomiting. The latter often was projectile in character, and in the young infants sometimes led to an erroneous diagnosis of pyloric stenosis. Pigmentation of the skin and mucous membranes was not a prominent finding. The characteristic blood findings consisted of a depression of sodium and chloride and an elevation of potassium. The fasting blood sugar was normal. Four of the five patients with adrenal insufficiency have been successfully controlled with the help of supplemental replacement therapy for periods up to six and one-half years. One patient with congenital Addison's disease died at the age of 10 months. Post-mortem study showed almost complete absence of the adrenal cortex and vascular changes of the kidneys, which probably resulted from overdosage with desoxycorticosterone acetate which had been given for the adrenal deficiency. Marked eosinophilia of the peripheral blood was present in several patients with adrenal insufficiency, and it is suggested that this abnormality be considered in certain patients with unexplained eosinophilia. Whatever the blood eosinophilia level may be, the manner in which injection of adrenocorticotropic hormone affects it constitutes a useful test of adrenal function, as pointed out by Forsham and collaborators. 16 In three patients excessive secretion of adrenal androgenic hormones was present simultaneously with the previously mentioned insufficiency of adrenal salt- and water-controlling hormones. Two of these patients were females in whom pseudohermaphroditism was thus produced. The other was a male with sexual precocity. Increased androgen secretion by the adrenal cortex was manifested by acceleration in the appearance of the epiphyseal centers, accelerated growth in the length of the long bones, precocious sexual development, and abnormally high excretion of 17-ketosteroids in the urine. The eruption of the permanent teeth was not markedly advanced in the 7-year-old patient with other evidences of precocious sexual and physical maturation. The increased excretion of 17-ketosteroids may be the only abnormal finding which is evident during the first year of life in a male patient with the adrenogenital syndrome. A family history of a similar condition was found in two of our female patients with pseudohermaphroditism and adrenal insufficiency. Knowledge of such previous familial occurrence may be of considerable help in the early recognition of congenital adrenal abnormality.

EXTREME EOSINOPHILIA AND LEUKOCYTOSIS

The purpose of this communication is to call attention again to a peculiar syndrome occurring in childhood and characterized by unexplained eosinophilia of marked degree, considerable increase in the total white cell count and general adenopathy with or without splenomegaly persisting over long periods. I have encountered 3 patients with this condition, on 2 of whom I have already published reports. I wish to report here the final outcome in the case of my second patient, who was reported on in 1931 but was followed up for seven years there-after, and to report the case of a third patient, whom I have had under observation for the past year and a half. SUMMARY OF TWO PREVIOUSLY REPORTED CASES In 1925, under the title Unusual Eosinophilia with Splenomegaly (Eosinophilic Leukemia?) in a Child Aged Six Years, 1 I reported my first case. During the two and a half months the