Samuel B. Adkins, III
Eosinophilia is an elevation of the peripheral eosinophil count above the normal value of 350 to 500 cells/mm3. It is most commonly associated with allergic disease (United States) or parasitic disease (worldwide) (1).
I. Approach. Eosinophilia occurs in many different conditions. A detailed history and physical examination will guide the testing and lead to a diagnosis.
II. History
A. Allergic disease. Included in this category are allergic rhinitis, asthma, atopic dermatitis, angioneurotic edema, and urticaria.
1. Allergic rhinitis can cause rhinitis, itchy eyes, pharyngitis, or cough.
2. Patients with asthma may complain of cough, chest pain, shortness of breath, or wheezing (Chapter 8.9).
3. Atopic dermatitis, angioneurotic edema, and urticaria all produce itchy rashes (Chapter 13.5).
4. Angioneurotic edema produces swelling of the oropharynx.
5. Urticaria produces a wheal and a flare-type rash (Chapter 13.7).
B. Parasitic disease. Strongyloidiasis, trichinosis, echinococcosis, cysticercosis, schistosomiasis, filariasis, and toxocariasis can all be associated with eosinophilia.
1. Abdominal pain and a change in bowel habits are common in gastrointestinal parasitic infection.
2. Consumption of infected meat can cause trichinosis and result in muscle soreness, malaise, and fever.
3. A history of travel to an area endemic for parasitic infections suggests parasitic infection as the cause of eosinophilia.
C. Neoplastic disease. Malignancies associated with eosinophilia include bronchogenic, cervical, liver, pancreatic, kidney, and breast carcinomas; Hodgkin’s lymphoma; and T-cell and eosinophilic leukemia (2).
1. Unexplained weight loss, night sweats, skeletal pain, change in bowel habits with or without bleeding, painless jaundice, and fatigue can indicate the presence of one of these malignancies.
2. A family history of one of these types of malignancies may be found.
D. Medications (prescription and over-the-counter). The list of medications that can produce eosinophilia includes phenytoin, sulfonamides, aspirin, allopurinol, and, in the past, contaminated l-tryptophan (eosinophilia myalgia syndrome) (3).
E. Collagen vascular disease. Systemic lupus erythematosus, polyarteritis nodosa, scleroderma, and the rare Churg–Strauss syndrome (hypereosinophilia, systemic vaculitis, and asthma) can have associated eosinophilia.
F. Adrenal insufficiency. Primary or secondary adrenal insufficiency can produce eosinophilia. Possible symptoms include fatigue, anorexia, nausea, hypotension, abdominal pain, and increased skin pigmentation.
G. Human immunodeficiency virus. Sexual promiscuity or sex with an infected partner, blood transfusion, and intravenous drug use are risk factors for human immunodeficiency virus (HIV).
H. Other eosinophilic syndromes. Eosinophilia is also seen in idiopathic hypereosinophic syndrome, Löffler’s syndrome (pulmonary symptoms with Ascaris infection), Will’s syndrome (pruritic rash), and Shulman’s syndrome (muscle pain and weakness).
III. Physical examination
A. All patients should have measurements of vital signs, as well as examination of the skin, lymph nodes, thyroid gland, breasts, heart, lungs, and abdomen. Adults should have pelvic and rectal examination.
B. Muscle and joint examinations should be done in symptomatic patients.
C. Neurologic examination should be done for patients suspected of having the idiopathic hypereosinophilic syndrome.
IV. Testing
A. Examination of the peripheral blood smear may reveal microcytic anemia, suggesting blood loss (parasitic disease or malignancy).
B. Urinalysis should be done looking for white blood cells and proteinuria.
C. Three stool specimens should be examined for ova and parasites.
D. The patient’s age, symptoms, and family history should direct cancer screening (colonoscopy, mammography, chest radiographs, and so on).
E. The patient’s history and physical examination should direct other testing (HIV, liver function tests, corticotropin stimulation test, chest radiographs, and so forth).
V. Diagnostic assessment. Determining the cause of eosinophilia requires knowledge of the possible causes and some detective work. Because of their frequency, allergic disease and parasitic infections must always be considered. Those patients who either lack symptoms or have nonspecific symptoms (e.g., weight loss, malaise, or fatigue), require a thorough history looking for increased risk of neoplastic, collagen vascular, immunodefiency or adrenal disease, which is then followed by appropriate laboratory testing. Several drugs (noted above) are known to cause eosinophilia. Others, which are not yet associated with eosinophilia, may also lead to this condition. These include prescription as well as over-the-counter products.
References
1. Rothenberg ME. Eosinophilia. N Engl J Med 1998;338:1592–1599.
2. Grathwohl K, LeBrun C, Tenglin R. Eosinophilia of the blood. Postgrad Med 1995;97:169–172.
3. Blackburn WD. Eosinophilia myalgia syndrome. Semin Arthritis Rheum 1997;26:
788–793.
Read excerpts from these other book chapters related to Eosinophilia:
Copyright Details: The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter, Copyright © 2008 Williams & Wilkins.
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More About This Book:
Title: The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter Authors: Robert B. Taylor (editor) Publisher: Lippincott Williams & Wilkins Copyright: 2000 ISBN: 0-78172-094-X 
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