Angiolymphoid hyperplasia with eosinophilia

The authors describe the case of a 38-year-old female patient suffering from angiolymphoid hyperplasia with eosinophilia. The symptoms, histopathology, differential diagnostic relations and the therapeutic modalities of this disease are discussed.     

Urticaria pigmentosa presenting with massive peripheral eosinophilia

Ovarian hyperstimulation syndrome has been reported following induction of ovulation with drug therapy for infertility. The ultrasonic and computed tomographic (CT) appearances of the ovarian cystic enlargement is described. The role of ultrasound in this condition is diagnostic; the results of which are supported by CT.     

Angiolymphoid hyperplasia with eosinophilia of the parapharyngeal space

Angiolymphoid hyperplasia with eosinophilia (ALHE) is an uncommon benign condition characterized by cutaneous nodules with a predeliction for the head and neck region. Extracutaneous involvement is rare. We report a 44-year-old woman who had a large submucosal ALHE tumour in the parapharyngeal space. Our patient is of interest because of the unusual, and as far as we are aware from the literature, unique site and presentation of her lesion.     

Tropical pulmonary eosinophilia

Tropical pulmonary eosinophilia (TPE) usually affects people living in the tropics, especially those in Southeast Asia, India, and certain parts of China and Africa. However, owing to the rising frequency of world-wide travel and the migration between continents, this disease is increasingly seen in the West, where the diagnosis can be easily missed since it is rarely encountered and can mimic many other conditions. Cases of TPE have typically been reported to masquerade as acute or refractory bronchial asthma. TPE results from a hypersensitivity reaction to lymphatic filarial parasites found in endemic regions. There is evidence that it is more likely to occur in nonimmune individuals, ie, visitors to endemic regions, than in individuals of endemic populations who have developed immunity to filarial infections. Clinical features include paroxysmal cough, wheezing and dyspnea, and systemic manifestations such as fever and weight loss. A history of residence in a filarial endemic region and a finding of peripheral eosinophilia >3,000/mm3 should initiate a consideration of this disease. Other criteria for the diagnosis of TPE include absence of microfilariae in the blood, high titers of antifilarial antibodies, raised serum total IgE >1,000 U/mL, and a favorable response to the antifilarial, diethylcarbamazine, which is the recommended treatment. This disease, if left untreated or treated late, may lead to long-term sequelae of pulmonary fibrosis or chronic bronchitis with chronic respiratory failure. Herein lies the importance of early diagnosis and treatment of TPE.     

Acquired platelet dysfunction with eosinophilia in white children

Acquired platelet dysfunction associated with eosinophilia has been described mainly in indigenous Southeast Asian and East Indian children. We describe two white boys in whom this disorder developed after they had lived in Malaysia for 12 to 18 months. Acquired platelet dysfunction associated with eosinophilia should therefore be considered in children who, after a visit to this region, have easy bruising and esoinophilia.     

Chronic pulmonary nocardiosis with eosinophilia in an immunocompetent host

A 75-year-old man who worked at a horse racing track, had an abnormal shadow on a chest radiography. He had a history of dilated cardiomyopathy and mitral regurgitation but had not had any respiratory or systemic symptoms for two years. Chest radiographs and CT scans showed slowly increasing consolidation with internal areas of low attenuation, and without cavity formation, at the left S8. The erythrocyte sedimentation rate, C-reactive protein level, WBC count, percentage of eosinophils, and IgE level were 35 mm/hr, negative, 8400, 17%, and 3628 IU/ml, respectively. Eosinophils were found in samples of sputum. His immunological status was normal. Transbronchial lung biopsy yielded necrotic tissue, along with gram-positive and irregular acid-fast branching filaments that grew in culture. The microorganism was identified as Nocardia asteroides. Occupational inhalation of soil may have caused his disease.     

Angiolymphoid hyperplasia with eosinophilia: report of 3 cases

Angiolymphoid hyperplasia with eosinophilia is reported in 3 patients. This lesion is an uncommon reactive vasoproliferative disorder which presents with swellings in the dermis and subcutis. The aetiological agent which produces this tissue response is unknown. Clinically the disease follows a benign prolonged course without evidence of systemic involvement. The histological features consist of a prominent fibroblastic and proliferative vascular reaction associated with an inflammatory infiltrate in which lymphoid aggregates with germinal centres and eosinophils are conspicuous.     

Endomyocardial fibrosis and eosinophilia

Absolute eosinophil counts were assessed in 15 African patients with proven endomyocardial fibrosis. Though the mean eosinophil count in patients with endomyocardial fibrosis was higher compared with the normals reported from Kampala (1-13 vs 0.72X10(9)/1), the absolute range was comparable. A high percentage of patients with endomyocardial fibrosis had malarial parasites, high malarial antibody titres, hookworms, or strongyloides, but the correlation of eosinophilia to various parasitic infections was poor. Both eosinophilia and parasitic infections are common in the tropics and they effect patients with endomyocardial fibrosis no more than the population at large. Other aetiological factors, genetic, environmental, and immunological, are felt to be important in the causation of endomyocardial fibrosis in Uganda and evidence for this is reviewed. Though there is a similarity in pathological features, African endomyocardial fibrosis is a distinct entity from L?ffler's endocarditis and cardiac lesions seen in eosinophilic leukaemia or reactive eosinophilia. There is no hard evidence to suggest that African endomyocardial fibrosis is a variant of L?ffler's endocarditis caused by parasitic infections via eosinophilia.     

Eosinophilia-myalgia syndrome, toxic-oil syndrome, and diffuse fasciitis with eosinophilia

The similarity of eosinophilia-myalgia syndrome (EMS) and toxic-oil syndrome (TOS) to systemic sclerosis and diffuse fasciitis with eosinophilia (DFE) highlights the potential for environmental agents to induce autoimmune disease. Further, a candidate etiologic agent for EMS, 3-(phenylamino)alanine, is chemically similar to the aniline derivative identified in samples of oil implicated in TOS, 3-(N-phenylamino)-1,2-propanediol, suggesting pathogenic overlap. The late-stage manifestations of EMS and TOS are muscle cramping, arthralgia, severe fatigue, and cognitive impairment. This review focuses on the divergent and parallel findings in EMS, TOS, and DFE. The formation of the Environmentally Associated Connective Tissue Disease Study Group within the American College of Rheumatology will provide a forum for the development of registries to study suspected toxin-induced disorders.     

Intermittent meningitic reaction with severe basophilia and eosinophilia in CNS leukaemia

Light- and electron-microscope studies were performed on CSF cells from a patient with CNS leukaemia presenting with an intermittent meningitic reaction. Numerous fully matured basophilic and eosinophilic granulocytes with excess glycogen content accompained undifferentiated leukaemic blast cells in the CSF. Such a CSF cell reaction has not been previously reported. It is suggested that this isolated CSF reaction represents a special type of immediate hypersensitivity reaction triggered by an abnormal leukaemic giant cell clone, and mitigated by the accompanying eosinophilic granulocytes.     

Myelodysplastic syndrome with bone marrow eosinophilia: clinical and cytogenetic features

We investigated the hematological and clinical status of 145 patients with de novo myelodysplastic syndrome (MDS), 14 of whom (10%) had eosinophilia in the bone marrow (MDS-Eo). Most of these 14 patients had severe anemia. Their bone marrow cells exhibited trilineage dysplasia and some morphological abnormalities in the eosinophils, including disproportion of eosinophilic granules, basophilic granules, a ring-shaped nucleus, and vacuolation in the cytoplasm. However, these abnormalities were less prominent than those of acute myelomonocytic leukemia with eosinophilia (FAB: M4Eo). Three of the 14 MDS-Eo patients had refractory anemia (RA), seven had RA with excess of blasts (RAEB), and four had RAEB in transformation. Cytogenetic analysis revealed chromosomal abnormalities in 12 of 13 MDS-Eo patients (92%), in particular, there were major karyotypic abnormalities (MAKA) in eight patients (62%). Cytotoxic agents were not effective in the treatment of four patients after leukemic transformation occurred. These four patients died of the leukemic transformation while seven died of bone marrow failure. The other three MDS-Eo patients are still alive; two of them have already transformed to a leukemic phase. The duration of survival of these patients was significantly shorter than that of the other MDS patients. These findings suggest that bone marrow eosinophilia in MDS may be a poor prognostic factor that is strongly related to the existence of MAKA.