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Fulltext Extreme Thrombocytosis in a Child: Laboratory Approaches and Diagnostic Challenges

Zulkafli Z, Janaveloo T, Wan Ab Rahman WS, Hassan MN, Abdullah WZ

Oman Med J, 2019 Jul;34(4):336-340.
PMID: 31360323 DOI: 10.5001/omj.2019.65

Thrombocytosis in children as well as in adult is defined as platelet count ≥ 450 × 109/L, and it is usually a reactive feature to various medical disorders. However, extreme thrombocytosis (platelet count ≥ 1000 × 109/L) is an uncommon finding among pediatric and adult patients, which may indicate more than a reactive phenomenon. We describe a case of a five-year-old boy who was admitted due to recurrent epistaxis. He had no history of allergic tendency or trauma. Physical examination was unremarkable except for shotty neck nodes. Laboratory results at presentation showed normal hemoglobin and total leukocyte count with eosinophilia (0.92 × 109/L), and extreme thrombocytosis. Other relevant investigations including coagulation profile, serum ferritin, liver, and renal function tests were all within normal ranges. Stool samples for ova and cysts were negative. The peripheral blood smear and bone marrow aspirate confirmed thrombocytosis with increased megakaryocytic proliferation and no artefactual reasons for the high platelets such as red blood cell fragments. Different causes of thrombocytosis in childhood were investigated after considering the possible differential diagnoses for extreme thrombocytosis.

Matched MeSH terms: Eosinophilia
Fulltext Cryptogenic pulmonary eosinophilia--a case report

Zainudin BM, Ismail O

Singapore Med J, 1990 Dec;31(6):629-31.
PMID: 2281365

A 44-year-old Indian housewife presented with prolonged cough, intermittent fever, loss of weight and shortness of breath on exertion. Physical examination revealed a thin lady with fine crackles on both lungs. Marked eosinophilia and elevated erythrocyte sedimentation rate were noted on peripheral blood. Chest radiograph showed characteristic bilateral infiltrates affecting the periphery of both lungs. Treatment with corticosteroid resulted in dramatic improvement in symptoms, signs and radiographic changes within a few days.

Matched MeSH terms: Pulmonary Eosinophilia/diagnosis*; Pulmonary Eosinophilia/radiography
Draft genome of neurotropic nematode parasite Angiostrongylus cantonensis, causative agent of human eosinophilic meningitis

Yong HS, Eamsobhana P, Lim PE, Razali R, Aziz FA, Rosli NS, et al.

Acta Trop, 2015 Aug;148:51-7.
PMID: 25910624 DOI: 10.1016/j.actatropica.2015.04.012

Angiostrongylus cantonensis is a bursate nematode parasite that causes eosinophilic meningitis (or meningoencephalitis) in humans in many parts of the world. The genomic data from A. cantonensis will form a useful resource for comparative genomic and chemogenomic studies to aid the development of diagnostics and therapeutics. We have sequenced, assembled and annotated the genome of A. cantonensis. The genome size is estimated to be ∼260 Mb, with 17,280 genomic scaffolds, 91X coverage, 81.45% for complete and 93.95% for partial score based on CEGMA analysis of genome completeness. The number of predicted genes of ≥300 bp was 17,482. A total of 7737 predicted protein-coding genes of ≥50 amino acids were identified in the assembled genome. Among the proteins of known function, kinases are the most abundant followed by transferases. The draft genome contains 34 excretory-secretory proteins (ES), a minimum of 44 Nematode Astacin (NAS) metalloproteases, 12 Homeobox (HOX) genes, and 30 neurotransmitters. The assembled genome size (260 Mb) is larger than those of Pristionchus pacificus, Caenorhabditis elegans, Necator americanus, Caenorhabditis briggsae, Trichinella spiralis, Brugia malayi and Loa loa, but smaller than Haemonchus contortus and Ascaris suum. The repeat content (25%) is similar to H. contortus. The GC content (41.17%) is lower compared to P. pacificus (42.7%) and H. contortus (43.1%) but higher compared to C. briggsae (37.69%), A. suum (37.9%) and N. americanus (40.2%) while the scaffold N50 is 42,191. This draft genome will facilitate the understanding of many unresolved issues on the parasite and the disorder it causes.

Matched MeSH terms: Eosinophilia/parasitology*
Fulltext NK/T cell lymphoma associated with peripheral eosinophilia

Yap E, Wan Jamaluddin WF, Tumian NR, Mashuri F, Mohammed F, Tan GC, et al.

Malays J Pathol, 2014 Dec;36(3):201-5.
PMID: 25500520 MyJurnal

NK/T cell lymphoma, nasal type is an aggressive and uncommon malignancy. Disease that occurs outside of the aerodigestive tract exhibits an even more aggressive clinical behaviour and does not respond as well to conventional therapy compared to its nasal counterpart. We report such a case of NK/T cell lymphoma, nasal type, that presented as an anterior chest wall mass, arising from the left pectoralis muscle. An interesting feature we wish to highlight is the associated eosinophilia that corresponded to disease activity, exhibiting fluctuations with surgical resection and chemotherapy. To the best of our knowledge this is the third reported case of NK/T cell lymphoma that is associated with peripheral eosinophilia. Our case highlights the role of certain NK cell subsets that play a major role in eosinophilic activation in NK/T lymphomas and calls for more research into further classification of this disease by virtue of its NK cell subsets.

Matched MeSH terms: Eosinophilia/pathology*
Filarial antibodies and eosinophilia in human subjects in an endemic area

Wong MM, Guest MF

Trans R Soc Trop Med Hyg, 1969;63(6):796-800.
PMID: 5368008
Matched MeSH terms: Eosinophilia/etiology*
Quantitative study of mast cells in Kimura's disease

Wong KT, Shamsol S

J Cutan Pathol, 1999 Jan;26(1):13-6.
PMID: 10189239

The association of mast cells with typical lesions of Kimura's disease was investigated by quantitative methods after immunohistochemical staining for Factor VIII-related antigen and counterstaining with toluidine blue. Formalin-fixed, paraffin-embedded, tissue sections from 9 confirmed cases of Kimura's disease were examined after staining to estimate mast cell and blood vessel densities by counting 100 random fields under oil immersion. There was a statistically significant increase of both mast cells and blood vessels in Kimura's disease (p<0.01) compared with normal skin and reactive lymph node controls. However, as far as the individual Kimura's disease lesion is concerned, there was generally no correlation between areas with mast cell increase and the degree of vascularity. Moreover, when lesions of less than 1 year's duration were compared with older lesions, there appeared to be a relative decrease in mast cells and a concomitant increase in vascularity in the latter. These results confirmed that mast cells are associated with Kimura's disease, and suggest that they may be involved in its early pathogenesis, although its possible role in angiogenesis may not be direct.

Matched MeSH terms: Angiolymphoid Hyperplasia with Eosinophilia/metabolism; Angiolymphoid Hyperplasia with Eosinophilia/pathology*
Eosinophilic gastroenteritis: Clinical profiles and treatment outcomes, a retrospective study of 18 adult patients in a Singapore Tertiary Hospital

Wong GW, Lim KH, Wan WK, Low SC, Kong SC

Med J Malaysia, 2015 08;70(4):232-7.
PMID: 26358020

BACKGROUND: Eosinophilic gastroenteritis (EG) can mimic symptoms of common gastrointestinal (GI) disorders but responds well to appropriate treatment. Accurate diagnosis is central to effective management. Data on EG in Southeast Asia is lacking. We aim to describe the clinical profiles and treatment outcomes of adult patients with EG in a Singapore Tertiary Hospital.
MATERIALS AND METHODS: This retrospective study involved archival search of patients with GI biopsies that showed eosinophilic infiltration from January 2004 to December 2012. Patients' clinical data from computerised hospital records and clinical notes was reviewed. Diagnostic criteria for EG included presence of GI symptoms with more than 30 eosinophils/high power field on GI biopsies. Patients with secondary causes for eosinophilia were excluded.
RESULTS: Eighteen patients with EG were identified (mean age 52 years; male/female: 11/7). Fifteen patients (83%) had peripheral blood eosinophilia. Seven patients (39%) had atopic conditions. Most common symptoms were diarrhoea and abdominal pain. Small intestine was the most common site involved. Endoscopic finding was non-specific. Ten patients were treated with corticosteroids (nine prednisolone, one budesonide): eight patients (89%) responded clinically to prednisolone but four patients (50%) relapsed following tapering-off of prednisolone and required maintenance dose. One patient each responded to diet elimination and montelukast respectively. Half of the remaining six patients who were treated with proton-pump inhibitors, antispasmodic or antidiarrheal agents still remained symptomatic.
CONCLUSION: Prednisolone is an effective treatment though relapses are common. Small intestine is most commonly involved. EG should be considered in the evaluation of unexplained chronic recurrent GI symptoms.

Matched MeSH terms: Eosinophilia
Aetiology of tropical eosinophilia

Webb JKG

The Indian Journal of Pediatrics, 1960;27:147-157.
DOI: 10.1007/BF02756459

1. The pathological changes in the lung, liver and lymph-nodes of typical cases of tropical pulmonary eosinophilia are described. 2. Microfilariae have been demonstrated in the centre of nodules in each of these tissues, suggesting that direct invasion by these organisms is the cause of the lesion in this disease. 3. Cases have been encountered with lymph-node and hepatic, but without lung involvement. The lesions in these cases are similar to those seen in the lung, and microfilariae are present. A plea is made to enlarge the concept of tropical eosinophilia to include such cases, and the same time to restrict it to those in which a filarial infection is proved or suspected. 4. Microfilariae recovered from lymph-nodes have been provisionally identified as W. bancrofti-type, but on the analogy of findings in Malaya, it is suggested that these may be of animal origin and that zoonotic filariasis remains the most likely explanation of tropical eosinophilia. © 1960 Dr. K C Chaudhuri Foundation.

Matched MeSH terms: Eosinophilia; Eosinophilia/etiology
Five cases of eosinophilic meningitis in Sarawak

Watts MB

Med J Malaya, 1969 Dec;24(2):89-93.
PMID: 4244149
Matched MeSH terms: Eosinophilia/drug therapy*
Diagnostic dilemma of kimura disease of eyelids

Ting SL, Zulkarnaen M, Than TA

Med J Malaysia, 2020 01;75(1):83-85.
PMID: 32008028

Kimura disease (KD) is a rare benign chronic inflammatory disease that presents as a nodule mostly involving deep subcutaneous tissue of the head and neck region with frequent regional lymphadenopathy and peripheral blood eosinophilia. KD shares some clinical and histopathological similarity with angiolymphoid hyperplasia with eosinophilia (ALHE). Consequently, KD and ALHE were once considered variants of the same disease spectrum. We present here rare cases of Kimura disease and ALHE involving the eyelid and lacrimal gland and discuss their differential features.

Matched MeSH terms: Angiolymphoid Hyperplasia with Eosinophilia/diagnosis*
Fulltext An update on HLA alleles as pharmacogenetic markers for antiepileptic drug-induced cutaneous adverse reaction

Then, Sue-Mian, Azman Ali Raymond

Neuroscience Research Notes, 2019;2(2):1-17.
MyJurnal

Epilepsy is a common neurological disorder affecting approximately 50 million people worldwide. Antiepileptic drugs (AEDs) are commonly used to treat the disease depending, mainlyon the type of seizure. However, the useof AEDs mayalso lead to cutaneous adverse drug reactions (cADR) such as toxic epidermal necrolysis (TEN), Stevens-Johnsonsyndrome (SJS), exfoliative dermatitis (ED) and drug‐induced hypersensitivity syndrome/drug reaction with eosinophilia and systemic symptoms (DIHS/DRESS), which are unwanted comorbidities in epilepsy. It was first discoveredthat the HLA-B*15:02 allele was strongly associatedwith carbamazepine(CBZ)-induced SJS/TEN amongHan Chinese and this ledto the discovery of other HLAallelesand cytochrome P450 (CYP) genes that were significantly associatedwith various AED-inducedcADRsacross variouspopulations. This mini-reviewis an update on the latest findings ofthe involvement of various HLA alleles and CYP alleles in cADRs caused by CBZ, phenytoin (PHT), oxcarbazepine (OXC) and lamotrigine(LTG) in different case-control studies around the world. From our review, we found that CBZ-and PHT-induced cADRsweremore commonly reportedthan the other AEDs.Therefore,there were morerobust pharmacogenetics studies related to these AEDs. OXC-and LTG-induced cADRswereless commonly reported,and somore studies are needed to validate the reported association of the newer reported HLA alleles with theseAEDs. It is also importantto considerthe allelic frequency within a given population before concludingthe use of thesealleles as genetic markers to prevent AED-induced cADR. Overall, the current body of research pointto a combination of alleles as a better pharmacogenetic marker comparedto the use of a single gene as a genetic marker for AED-induced cADR.

Matched MeSH terms: Eosinophilia
Fulltext Clozapine and Polycythemia Rubra Vera: a rare side effect or a separate medical condition? – a case report

Tan, H.P.J.

Malaysian Journal of Psychiatry, 2016;25(2):0-0.
MyJurnal

This article highlights the case of a 44-year old Malay man who is diagnosed as having treatment resistant schizophrenia on Clozapine, which then developed Polycythemia Rubra Vera (PRV). It is known that a major side effect for Clozapine is of agranulocytosis, that is a potentially fatal side effect. However, there have been reported disturbances of other hematological parameters, which result in other abnormalities including leucopenia, leucocytosis, thrombocytopenia, thrombocytosis and eosinophilia. Could this case be a pure medical condition of PRV or is there a relation to the effects of Clozapine? In this paper, the aim is to report a case of blood dyscrasia in a 44-year old male who developed Polycythemia Rubra Vera a year after he was observed to have abnormal full blood count results.

Matched MeSH terms: Eosinophilia
Fulltext A case report of severe Ascariasis infection in systemic lupus erythematosus patient

Tan J. Y. S., R. Surendran, Mohd Noh Malehah, Shaila Kabir, Chong Y. Y. Eleen

Malaysian Journal of Medicine and Health Sciences, 2019;15(106):53-53.
MyJurnal

Introduction: Ascariasis is a parasitic infection, which commonly affects immunocompromised patients. Most pa-tients remained asymptomatic during the early larval migration stage and respond well with conventional anti-hel-minthic drugs. Previous literature had reported symptomatic Ascaris infection mimicking bacterial pneumonia and the typical eosinophilia found in Loeffler syndrome was absent in patients on corticosteroids. Thus, a high index of suspicion for ascariasis is needed for immunosuppressed patients presented with infection. We present here a case of severe ascariasis infection in a systemic lupus erythematosus patient. Case description: A 16-year-old boy presented with fever, generalized maculopapular rash associated with neutropenia and thrombocytopenia. He was treated initially as Dengue Fever initially. However his symptoms did not resolve at even day 14 of admission. On further assessment, we were convinced he has SLE based upon presence of malar rash, oral ulcers, urinary protein-uria, persistent leucopenia, thrombocytopenia with low complements and ANA positive. He was promptly started on IV hydrocortisone. He showed a good progress in the first few days. On day 5 of admission, he coughed out a round worm which later identified as Ascarisis lumbricoides. He was started on Albendazole. Unfortunately he developed hemoptysis and respiratory compromisation where he required intubation. Post intubation he went into cardiac arrest, which required CPR. Following that event, his condition further deteriorated with multi organ failure. He succumbed to his illness three days later. Conclusion: Immunocompromised patients are prone to opportunistic infections including parasitic infections. we present here a case of ascariasis in an SLE patient who unfortunately succumbed to the illness. Due to the variable clinical symptoms that mimic other infections, screening for parasitic infections needs to be considered especially if the patients do not respond to antibiotics and routine treatments.

Matched MeSH terms: Eosinophilia
Fulltext Cutaneous Vasculitis as Early Presentation of Eosinophilic Granulomatosis with Polyangiitis without Systemic Symptoms

Sulaiman W, Abdullah AC, Chung SF, Karim N, Tang JJ

Oman Med J, 2019 Jul;34(4):345-349.
PMID: 31360325 DOI: 10.5001/omj.2019.67

Eosinophilic granulomatosis with polyangiitis (formerly known as Churg-Strauss syndrome) is a rare vasculitis in children. It commonly presents with respiratory symptoms, especially asthma, allergic rhinitis, and peripheral eosinophilia. Involvement of other systems, such as renal and cardiac, may carry a poor prognosis. Anti-neutrophil cytoplasmic antibodies have been found less frequently in children with this condition. We report a case of a 15-year-old male who presented with indurated and pruritic papules on both legs and peripheral eosinophilia without other system involvement. Histopathological findings from a skin biopsy were suggestive of eosinophilic granulomatosis with polyangiitis. Anti-neutrophil cytoplasmic antibodies were negative.

Matched MeSH terms: Eosinophilia
Immunoglobulin levels in various clinical groups of human Brugian filariasis in Malaysia

Sim BK, Mak JW, Kwa BH

Z Parasitenkd, 1983;69(3):371-5.
PMID: 6880344

Quantitation of serum immunoglobulin M, G, A, D and E levels was carried out in Malaysians with Brugia malayi infections. Results showed highly elevated levels of IgM and IgE as well as moderately elevated levels of IgG. These were most significant in patients with tropical pulmonary eosinophilia or elephantiasis. Serum IgE levels were extremely high in microfilaraemic patients (6,060 +/- 3,958 IU ml) probably due to a constant antigenic stimulation by dead and dying microfilariae.

Matched MeSH terms: Pulmonary Eosinophilia/etiology; Pulmonary Eosinophilia/immunology
Fulltext Kimura's Disease: Diagnostic Challenge and Treatment Modalities

Sia KJ, Kong CK, Tan TY, Tang IP

Med J Malaysia, 2014 Dec;69(6):281-3.
PMID: 25934961

CASE REPORT: Five cases of Kimura's disease had been treated in our centre from year 2003 to 2010. All cases were presented with head and neck mass with cervical lymphadenopathy. Surgical excision was performed for all cases. Definite diagnosis was made by histopathological examination of the resected specimens. One out of five cases developed tumour recurrence four years after resection.

CONCLUSION: Surgical excision is our choice of treatment because the outcome is immediate and definite tissue diagnosis is feasible after resection. Oral corticosteroid could be considered as an option in advanced disease. However, tumour recurrence is common after cessation of steroid therapy.

Matched MeSH terms: Angiolymphoid Hyperplasia with Eosinophilia
Fulltext Kimura's disease in Malay patients

Shahrul H, Baharudin A, Effat O

Med J Malaysia, 2007 Aug;62(3):263-4.
PMID: 18246925 MyJurnal

Kimura's Disease (KD) is an uncommon, chronic inflammatory disorder of unknown etiology which is endemic in Orientals. It is characterized by painless, large solitary or multiple nodules in subcutis of head and neck region or the major salivary glands, associated with regional lymphadenopathy, blood eosinophilia and elevated IgE levels. Its treatment ranging from conservative observation in asymptomatic patient to surgical resection of the mass, corticotherapy and irradiation therapy for the symptomatic ones.

Matched MeSH terms: Angiolymphoid Hyperplasia with Eosinophilia/diagnosis; Angiolymphoid Hyperplasia with Eosinophilia/physiopathology*; Angiolymphoid Hyperplasia with Eosinophilia/therapy
Intestinal helminths in relation to eosinophilic lung (tropical eosinophilia) in Singapore

Schacher JF, Danaraj TJ

Am J Trop Med Hyg, 1960 Nov;9(6):616-9.
PMID: 13747131

The above survey based on a study of single stool specimens from 569 patients, drawn from a hospital population belonging to different ethnic groups and having different cultural backgrounds, failed to indicate an association between intestinal helminth infection and eosinophilic lung. The higher prevalence of eosinophilic lung in Indians than in the other ethnic groups, as reported previously, cannot be explained on a basis of differences in the prevalence of the intestinal helminths, Ascaris lumbricoides, hookworm, Trichuris trichiura and Strongyloides stercoralis.

Matched MeSH terms: Eosinophilia/complications*
Fulltext Traumatic ulcerative granuloma with stromal eosinophilia - Mystery of pathogenesis revisited

Sarangarajan R, Vaishnavi Vedam VK, Sivadas G, Sarangarajan A, Meera S

J Pharm Bioallied Sci, 2015 Aug;7(Suppl 2):S420-3.
PMID: 26538890 DOI: 10.4103/0975-7406.163474

Oral ulcers are a common symptom in clinical practice. Among various causative factors, different types of ulcers in oral cavity exist. Among this, traumatic ulcerative granuloma with stromal eosinophilia (TUGSE) appears to be quite neglected by the clinicians due to the limited knowledge and awareness. On reviewing with a detailed approach to titles and abstracts of articles eliminating duplicates, 40 relevant articles were considered. Randomized studies, review articles, case reports and abstracts were included while conference papers and posters were excluded. Of importance, TUGSE cases been reported only to a minimal extent in the literature. Lack of its awareness tends to lead clinicians to a misconception of cancer. Thus, this particular lesion needs to be differentiated from other malignant lesions to provide a proper mode of treatment. The present article reviews various aspects of the TUGSE with emphasis on the clinical manifestation, pathogenesis, histological, and immunohistochemical study. This study provides the clinician contemporaries, a humble expansion to their knowledge of the disease, based on the searched literature, enabling a more comprehensive management of this rare occurrence.

Matched MeSH terms: Eosinophilia
Seropositivity and risk factors of Toxocara canis infection in adult asthmatic patients

Rouhani-Rankouhi SZ, Kow KS, Liam CK, Lau YL

Trop Biomed, 2020 Sep 01;37(3):599-608.
PMID: 33612775 DOI: 10.47665/tb.37.3.599

This cross-sectional study involving 86 adult asthmatic patients aimed to determine the relationship between Toxocara seropositivity and severity of asthma in adult asthmatics and investigate the risk factors for Toxocara infection. In all cases, T. canis IgG level was measured using an anti-Toxocara IgG enzyme-linked immunosorbent assay kit. Total serum IgE and eosinophil count were also determined. The anti-Toxocara IgG seropositivity was 68.6% among asthmatic patients. There were no statistically significant associations between Toxocara seroprevalence and other risk factors, clinical symptoms of asthma and high level of total serum IgE and eosinophilia. Pet ownership could be an important risk factor for Toxocariasis. Having a pet at home and wheezing were significantly associated with Toxocara seropositivity in adult asthmatic patients.

Matched MeSH terms: Eosinophilia

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