PERIPHERAL eosinophilia

PERIPHERAL EOSINOPHILIA

Background: The accumulation of eosinophils in a variety of tissues is not unique to host defense or as result of immune dysregulation, this buildup occurs as a strategy to maintain homeostasis in both states: health and disease. Eosinophilia is considered to occur when the total number of eosinophils in the periphery is significantly higher than considered normal for the general population 

Objective: To present the clinical case of a patient with peripheral eosinophilia, which one did not show apparent trigger.

Medical history and monitoring: 5 years old Male patient, evaluated by our allergy group for  3-month history of cervical lymphadenopathy associated with fever, current  edema  in hands and feet and  itchy, his laboratory test revealed  eosinophils between 1860 and 9500cell/ml. Studies were conducted to rule out to rule out causes of peripheral eosinophilia. HIV, toxocara, CMV, Toxoplasma antibodyes has done , cerebrospinal fluids cytology, IgE, bone marrow biopsy, echocardiography, upper gastrointestinal endoscopy, colonoscopy  and biopsies all within normal ranges.

By peripheral eosinophilia, recurrent fever and swelling hands Gleich syndrome was thought , which is characterized by recurrent episodes of angioedema, urticaria, itchy, fever, weight gain, elevated IgM and leukocytosis with marked eosinophilia.  Requested to continue with the studios vit B12 levels, IgM, skin biopsy with immunohistochemistry and serum levels of tryptase, Finding high levels of Vit B12: 1018 pg / ml, normal tryptase and IgM.  skin biopsy was not carried out  because the skin symptoms and eosinophilia resolved.     

 It highlights the need for diagnostic studies in patients with hypereosinophilia in order to reach an etiological diagnosis. In our patient suspected Gleich syndrome, but the normalization of the eosinophil count four months after without drug treatment and the  absence of physical signs, now ruled out the diagnosis and force us to make periodic checks.

Bibliography: The eosinophilias, including the idiopathic hypereosinophilic syndrome. Briito Babapulle. J Haematol 2003.                

Eosinophilia and Eosinophil-Related Disorders Peter F. Weller Middleton's Allergy: Principles and Practice, 7th ed.N