Dr. Zhou presented an interesting case of a young previously healthy female with sub-acute relapsing periarticular edema and hypereosinophilia, ultimately felt to be secondary to lymphocytic variant of HES.
She shared her ddx for eosinophilia (CHINAA)
C – connective tissue diseases, e.g. eGPA, GPA, RA, dermatomyositis, scleroderma, Sjogren’s, SLE, Behcet’s IgG-related disease, APLS, immunodeficiencies
H – helminths
I – idiopathic (HES)
N – neoplasms, e.g. AEL, CEL, CML, systemic mastocytosis, B cell lymphoma, T cell lymphomas/leukemias, solid tumors (esp. GI tract, lungs, SCCs)
A – allergies, e.g. asthma, DRESS, ABPA
A – adrenal insufficiency
HES: AEC >1500 on 2 occasions + evidence of organ dysfunction
Primary HES: Due to neoplasm/clonal expansion
Secondary: Due to other etiologies (noted above, with helminth infections being the most common) , certain solid tumors, and T-cell lymphoma. Lymphocytic variant HES is a sub-variant in this category.
Patients with primary eosinophil counts > 100K/or rapidly rising eosinophil counts should be urgently referred to hematology and started on empiric treatment (pulse dose steroids + ivermectin if strongyloides positive).