Eosinophilia Everywhere

Today we talked about an interesting patient from East Africa who presented with a chronic cough and was found to have eosinophilia.  We discussed the differential for both eosinophilia and for hypoxia and eosinophilia. 

1. The differential for hypereosinophilia and hypoxia:

-Acute eosinophilic pneumonia, simple pulmonary eosinophilia, chronic eosinophilic pneumonia

-EGPA

-Infection:

        -ABPA

        -Strongyloides

        -Ascaris lumbricoides

        -Toxocara canis

        -Tropical Pulmonary Eosinophilia (Wuchereria bancrofti and Brugia malayi)

        -PJP

2. Chronic Eosinophilic Pneumonia:

-A rare interstitial lung disease with subacute or chronic symptoms, elevated blood and/or alveolar eosinophils, and often peripheral pulmonary infiltrates on imaging. 

-Patients are often women (2:1), non-smokers, with peak incidence in the 50s, with the majority (50-60%) having asthma or atopy. 

-Must rule out alternative diagnosis

-Treated with oral steroids.  +/- inhaled corticosteroids.