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Cetinkaya PG, Aytekin ES, Esenboga S, Cagdas D, Sahiner UM, Sekerel BE, Soyer O. Eosinophilia in children: characteristics, etiology and diagnostic algorithm. Eur J Pediatr 2023:10.1007/s00431-023-04961-x. [PMID: 37041294 DOI: 10.1007/s00431-023-04961-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 03/22/2023] [Accepted: 03/30/2023] [Indexed: 04/13/2023]
Abstract
Eosinophilia is common in children and may be caused by various disorders. Large-cohort studies, including mild cases, are limited in children. This study aimed to reveal underlying etiologies of childhood eosinophilia and to create a diagnostic algorithm. Children (< 18 years) with absolute eosinophil counts (AECs) ≥ 0.5 × 109/L were reviewed from medical files. Clinical characteristics and laboratory values were recorded. Patients were grouped based on the severity of eosinophilia as mild (0.5-1.5 × 109/L), moderate (≥ 1.5 × 109/L) and severe (≥ 5.0 × 109/L). An algorithm was formed to evaluate these patients. We included 1178 children with mild (80.8%), moderate (17.8%) and severe eosinophilia (1.4%). The most common reasons of eosinophilia were allergic diseases (80%), primary immunodeficiency (PID) (8.5%), infectious diseases (5.8%), malignancies (0.8%) and rheumatic diseases (0.7%). Only 0.3% of children presented with idiopatic hypereosinophilic syndrome. Allergic diseases and PIDs were the most common etiologies in mild/moderate and severe groups, respectively. The median duration of eosinophilia was 7.0 (3.0-17.0) months in the study population and was the shortest in severe cases (2.0 (2.0-5.0) months). Multiple logistic regression analysis demonstrated food allergy [OR:1.866, 95%CI:1.225-2.842, p = 0.004] and PIDs [OR:2.200, 95%CI:1.213-3.992, p = 0.009] as independent factors for childhood eosinophilia. A diagnostic algorithm including mild form was presented for childhood eosinophilia. Conclusion: Eosinophilia was frequently determined due to secondary causes; allergic diseases in mild/moderate eosinophilia, PIDs in severe group. Etiology of eosinophilia was diverse, and an algorithm concerning the severity of eosinophilia would be practical and rational. What is Known: • In children, eosinophilia is common, and mild eosinophilia occurs frequently. • Malignancies presents frequently with severe eosinophilia. What is New: • Primary immunodeficiencies were not a rare cause of eosinophilia, especially in countries such as the Middle East and eastern Mediterranean countries, where the countries consanguineous marriages are common, and should be investigated in children with eosinophilia who do not have allergic or infectious diseases. • In literature, there are many algorithms about childhood hypereosinophilia. However, mild eosinophilia is extremely important in children. Because all patients with malignancy and most of the patients with rheumatic diseases presented with mild eosinophilia. Therefore, we proposed an algorithm for childhood eosinophilia that includes mild eosinophilia besides moderate and severe cases.
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Affiliation(s)
- Pınar Gur Cetinkaya
- Division of Pediatric Allergy and Asthma Unit, Department of Pediatrics, Faculty of Medicine, Hacettepe University, 06410, Sıhhiye, Ankara, Turkey
| | - Elif Soyak Aytekin
- Division of Pediatric Allergy and Asthma Unit, Department of Pediatrics, Faculty of Medicine, Hacettepe University, 06410, Sıhhiye, Ankara, Turkey
| | - Saliha Esenboga
- Division of Pediatric Immunology, Department of Pediatrics, Faculty of Medicine, Hacettepe University, 06410, Sıhhiye, Ankara, Turkey
| | - Deniz Cagdas
- Division of Pediatric Immunology, Department of Pediatrics, Faculty of Medicine, Hacettepe University, 06410, Sıhhiye, Ankara, Turkey
| | - Umit Murat Sahiner
- Division of Pediatric Allergy and Asthma Unit, Department of Pediatrics, Faculty of Medicine, Hacettepe University, 06410, Sıhhiye, Ankara, Turkey
| | - Bulent Enis Sekerel
- Division of Pediatric Allergy and Asthma Unit, Department of Pediatrics, Faculty of Medicine, Hacettepe University, 06410, Sıhhiye, Ankara, Turkey
| | - Ozge Soyer
- Division of Pediatric Allergy and Asthma Unit, Department of Pediatrics, Faculty of Medicine, Hacettepe University, 06410, Sıhhiye, Ankara, Turkey.
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2
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Gho DS, Cooper RM. Pediatric Acute Lymphoblastic Leukemia With Hypereosinophilia and IDH2 Gene Mutation: A Case Report and Literature Review. J Pediatr Hematol Oncol 2022; 44:e546-e549. [PMID: 34966098 DOI: 10.1097/mph.0000000000002375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 11/02/2021] [Indexed: 11/25/2022]
Abstract
Eosinophilia is a rare presentation of acute lymphoblastic leukemia (ALL) within the pediatric population. In this report, we present a patient with pre-B ALL and eosinophilia in the setting of an isocitrate dehydrogenase-2 gene mutation. These mutations have been described in patients with acute myeloid leukemia but in very few patients with ALL.
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3
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Ogueri VN, Mellor JR, Muralidhar N, MacDonell-Yilmaz R, Welch JJG, Goudie BW, Agarwal S, Rozenfeld RA. Acute Myocardial Dysfunction and Hypereosinophilic Infiltrative Myocarditis Secondary to New-Onset Pediatric Acute Lymphoblastic Leukemia. JACC Case Rep 2021; 3:991-996. [PMID: 34317671 PMCID: PMC8311379 DOI: 10.1016/j.jaccas.2021.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 03/12/2021] [Accepted: 03/24/2021] [Indexed: 11/29/2022]
Abstract
Myocardial infiltration by eosinophils leads to myocardial inflammation and fibrosis, resulting in restrictive hemodynamics. We describe an uncommon presentation of eosinophilic predominant acute lymphoblastic leukemia that manifested with hypereosinophilic infiltrative myocarditis. (Level of Difficulty: Advanced.)
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Affiliation(s)
- Vanessa N Ogueri
- Department of Pediatrics, Hasbro Children's Hospital, Providence, Rhode Island, USA
| | - Joshua R Mellor
- Department of Pediatrics, Hasbro Children's Hospital, Providence, Rhode Island, USA
| | - Nivedita Muralidhar
- Department of Pediatrics, Hasbro Children's Hospital, Providence, Rhode Island, USA
| | - Rebecca MacDonell-Yilmaz
- Department of Pediatrics, Hasbro Children's Hospital, Providence, Rhode Island, USA.,Division of Hematology/Oncology, Department of Pediatrics, Hasbro Children's Hospital, Providence, Rhode Island, USA
| | - Jennifer J G Welch
- Department of Pediatrics, Hasbro Children's Hospital, Providence, Rhode Island, USA.,Division of Hematology/Oncology, Department of Pediatrics, Hasbro Children's Hospital, Providence, Rhode Island, USA
| | - Brett W Goudie
- Department of Pediatrics, Hasbro Children's Hospital, Providence, Rhode Island, USA.,Division of Cardiology, Department of Pediatrics, Hasbro Children's Hospital, Providence, Rhode Island, USA
| | - Saurabh Agarwal
- Division of Cardiothoracic Imaging, Department of Diagnostic Imaging, Rhode Island Hospital, Providence Rhode Island, USA
| | - Ranna A Rozenfeld
- Department of Pediatrics, Hasbro Children's Hospital, Providence, Rhode Island, USA.,Division of Critical Care Medicine, Department of Pediatrics, Hasbro Children's Hospital, Providence, Rhode Island, USA
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4
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B-acute Lymphoblastic Leukemia With Hypereosinophilia Associated With Severe Cardiac Complications: A Clinical Case. J Pediatr Hematol Oncol 2021; 43:e51-e55. [PMID: 33122584 DOI: 10.1097/mph.0000000000001975] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Hypereosinophilia (HE) is rare but often secondary to a nonhematologic disease such as allergic disorders and parasitic infections. HE can also be associated with hematologic malignancies and be the result of a clonal proliferation or reactive to another hematologic condition. Association of HE with acute lymphoblastic leukemia (ALL) is rare in children. We reported a case of a teenager presented with HE secondary to B-ALL who experienced severe cardiac complications with severe absolute eosinophil count. We compared his clinical evolution with other published cases and we reported 2 mutations linked to B-ALL never described before in this context.
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5
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Shahriari M, Shakibazad N, Haghpanah S, Ghasemi K. Extramedullary manifestations in acute lymphoblastic leukemia in children: a systematic review and guideline-based approach of treatment. AMERICAN JOURNAL OF BLOOD RESEARCH 2020; 10:360-374. [PMID: 33489446 PMCID: PMC7811904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Accepted: 12/04/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Acute lymphoblastic leukemia (ALL) may present with signs and symptoms related to extramedullary involvement, therefore, leads to delayed diagnosis of ALL in children. This study aims to consider the extramedullary manifestations of ALL in children and their proper treatment. METHOD The databases were searched for all relevant subjects including "acute lymphoblastic leukemia", "clinical presentation", "unusual presentation", "childhood acute lymphoblastic leukemia", "presenting features of ALL", "extramedullary presentation", and "atypical presentation" from April 1968 to June 2020. The Inclusion criteria for this review study were all cases reported, case series, and studies about extramedullary presentations of ALL in pediatrics. Eighty-seven studies had inclusion criteria. All reported studies were analyzed given their extramedullary presentations, age, sex, treatment option, and prognostic factors. A two-sided P-value less than 0.05 was considered statistically significant. RESULT In this review study, the extramedullary initial signs and symptoms of ALL were related to musculoskeletal system 17 (19.5%) especially bony symptoms and hypercalcemia. The additional extramedullary presentations of ALL in order of frequency include; renal involvement, 17 (19.5%), hepatic symptom 12 (13.8%), orbital presentation 10 (11.5%), neurologic signs 8 (9%), dermatological manifestations 5 (5.8%), oral presentations 5 (5.8%), hypereosinophilia 5 (5.8%), abdominal manifestation 3 (3.5%), pericardial involvement 2 (2.3%), and the other miscellaneous presentations 3 (3.5%). CONCLUSION The clinicians must become familiar with these extramedullary presentations of ALL in pediatrics to avoid the delayed diagnosis of this disease and increase the probable chance of survival by early detection.
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Affiliation(s)
- Mahdi Shahriari
- Hematology Research Center, Shiraz University of Medical SciencesShiraz, Iran
| | - Nader Shakibazad
- Department of Pediatric Hematology and Oncology, Bushehr University of Medical SciencesBushehr, Iran
- Hematology Research Center, Shiraz University of Medical SciencesShiraz, Iran
| | - Sezaneh Haghpanah
- Hematology Research Center, Shiraz University of Medical SciencesShiraz, Iran
| | - Khadijeh Ghasemi
- Department of Pediatric Nephrology, Bushehr University of Medical SciencesBushehr, Iran
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Narayanan G, Soman LV, Kumar R. Hypereosinophilia: A rare presentation of acute lymphoblastic leukaemia. J Postgrad Med 2019; 64:50-52. [PMID: 28862246 PMCID: PMC5820816 DOI: 10.4103/jpgm.jpgm_681_16] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Acute lymphoblastic leukaemia (ALL) presenting as peripheral blood hypereosinophilia is very rare and the incidence is <1%. The characteristic feature of patients with ALL and hypereosinophilia is the absence of blasts in peripheral blood, and this might lead to misdiagnosis of ALL. It is important for clinicians and pathologists to be aware of this uncommon initial presentation of ALL to avoid delay in diagnosis. We report a 37-year-old man who presented with fever and respiratory symptoms and was found to have hypereosinophilia in peripheral blood. His bone marrow and lymph node biopsies were diagnostic of ALL.
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Affiliation(s)
- G Narayanan
- Department of Medical Oncology, Regional Cancer Centre, Thiruvananthapuram, Kerala, India
| | - L V Soman
- Department of Medical Oncology, Regional Cancer Centre, Thiruvananthapuram, Kerala, India
| | - R Kumar
- Department of Medical Oncology, Regional Cancer Centre, Thiruvananthapuram, Kerala, India
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7
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Mallika L, Sowmya SV, Rao RS, Augustine D, Haragannavar VC, Nambiar KS. Cocktail of Periodic Acid-Schiff and Papanicolaou: Novel staining technique for the identification of leukemic eosinophils - A pilot study. J Oral Maxillofac Pathol 2019; 23:476. [PMID: 31942140 PMCID: PMC6948061 DOI: 10.4103/jomfp.jomfp_8_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background Tissue eosinophilia may be caused due to reactive, neoplastic or idiopathic reasons. Reactive eosinophils in allergic and inflammatory conditions are transient and recruited from the circulation in response to various stimuli, whereas neoplastic eosinophils of leukemias and hematological malignancies are involved in the pathogenesis of the disease. The differentiation of reactive from neoplastic eosinophils has a serious implication on the treatment and prognosis of diseases. However, both these types of eosinophils display variation in morphology and staining characteristics in routine histopathology leading to a diagnostic dilemma. Aim The aim of this study is to evaluate the efficacy of special stains for the demonstration of eosinophils in normal/reactive lesions and leukemias. Methodology A retrospective study comprising twenty histologically diagnosed cases each of reactive oral lesions and leukemias were obtained from institutional archives. These tissue sections were subjected to staining with routine and special stains - Carbol chromotrope, Congo red, Leishman's stain, Periodic Acid-Schiff-papanicolaou (PAS-PAP) and PAS. Statistical analysis was performed using Pearson's Chi-square test to compare the various parameters in the evaluation of the staining efficacy. Results Carbol chromotrope and Congo red staining showed increased staining efficacy in normal/reactive eosinophils while PAS-PAP followed by PAS and Leishman's stain showed enhanced features such as homogenicity, specificity, increased staining intensity, enhanced nuclear and cytoplasmic details in leukemic eosinophils. Conclusion Combined PAS-PAP is a novel and cost-effective staining technique in differentiating reactive and leukemic eosinophils. It is significant in recognizing leukemic eosinophils of routine biopsies and alerts the clinician to rule out any underlying malignancies.
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Affiliation(s)
- Lavanya Mallika
- Department of Oral Pathology and Microbiology, Faculty of Dental Sciences, M. S. Ramaiah University of Applied Sciences, Bengaluru, Karnataka, India
| | - S V Sowmya
- Department of Oral Pathology and Microbiology, Faculty of Dental Sciences, M. S. Ramaiah University of Applied Sciences, Bengaluru, Karnataka, India
| | - Roopa S Rao
- Department of Oral Pathology and Microbiology, Faculty of Dental Sciences, M. S. Ramaiah University of Applied Sciences, Bengaluru, Karnataka, India
| | - Dominic Augustine
- Department of Oral Pathology and Microbiology, Faculty of Dental Sciences, M. S. Ramaiah University of Applied Sciences, Bengaluru, Karnataka, India
| | - Vanishri C Haragannavar
- Department of Oral Pathology and Microbiology, Faculty of Dental Sciences, M. S. Ramaiah University of Applied Sciences, Bengaluru, Karnataka, India
| | - K Shwetha Nambiar
- Department of Oral Pathology and Microbiology, Faculty of Dental Sciences, M. S. Ramaiah University of Applied Sciences, Bengaluru, Karnataka, India
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8
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Schwartz JT, Fulkerson PC. An Approach to the Evaluation of Persistent Hypereosinophilia in Pediatric Patients. Front Immunol 2018; 9:1944. [PMID: 30233571 PMCID: PMC6130221 DOI: 10.3389/fimmu.2018.01944] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 08/07/2018] [Indexed: 01/21/2023] Open
Abstract
Hypereosinophilia (HE) is currently defined by a peripheral blood absolute eosinophil count (AEC) of ≥1,500 cells/microL. Although mild blood eosinophilia (AEC 500–1,500 cells/microL) is observed relatively frequently within the pediatric population, persistent HE is uncommon and should prompt additional clinical evaluation. While the clinical manifestations and underlying etiologies of HE in adults have been well-characterized, there is a paucity of data on HE in children. Limited evidence suggests that many similarities between adult and pediatric HE likely exist, but some important differences remain between these populations. The evaluation of HE in children can be challenging given the broad differential diagnosis, which includes primary hematologic disorders and secondary eosinophilia in which the increased eosinophil levels are propagated by disease states that promote eosinophil production and survival. On the basis of the underlying etiology, clinical manifestations can range from benign, self-resolving elevations in the AEC to life-threatening disorders with the potential for significant end-organ damage. Given the broad differential diagnosis of HE, it remains essential to systematically approach the evaluation of unexplained HE in children. This review will discuss the differential diagnosis for pediatric HE, highlighting etiologies that are more prevalent within the pediatric population. Additionally, a summary of the epidemiology of pediatric HE will be presented, with focus on some of the differences that exist between pediatric and adult HE. Finally, a directed approach to the diagnostic evaluation of children with HE will be discussed.
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Affiliation(s)
- Justin T Schwartz
- Division of Allergy and Immunology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Patricia C Fulkerson
- Division of Allergy and Immunology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, United States
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9
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Acute Lymphoblastic Leukemia with Hypereosinophilia in a Child: Case Report and Literature Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15061169. [PMID: 29867057 PMCID: PMC6025476 DOI: 10.3390/ijerph15061169] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 05/28/2018] [Accepted: 05/31/2018] [Indexed: 01/04/2023]
Abstract
Background: Hypereosinophilia in children can be primary or secondary. Numerous malignant diseases can cause hypereosinophilia, but it is seldom caused by acute lymphoblastic leukemia (ALL). In the event of protracted hypereosinophilia, it is extremely important to make a correct differential diagnosis. Case presentation: We present the case of an 11-year-old boy of Moroccan origin with ALL with hypereosinophilic onset (eosinophils in peripheral blood, 10,000/µL) in the absence of other signs of neoplastic disease, and compare this case with 61 similar cases in the literature. Following hospital admission, the patient initially presented with headache-caused nocturnal awakenings, evening fever, and cough, and he also lost approximately 7 kg in weight in a month not associated with sweating or itching. We first performed bone marrow aspiration, which showed an increase in eosinophils without cellular morphological abnormalities, and bone marrow immunophenotyping showed that 4.5% of cells had a phenotype compatible with lymphoid blasts. A lumbar puncture was negative. Given the poor marrow involvement, it was necessary to repeat a new bone marrow aspiration two days later, which showed an increase in blasts to 14%. A concomitant bone marrow biopsy showed an infiltration of blasts typical of B-cell ALL equal to 20–30% with associated hypereosinophilia. Cytogenetic analysis showed an hyperdiploid karyotype: 53–55, XY, +X, add(1)(q21q25), +4, +9, +10, +14, +2, +1, +21/46, XY. Conclusions: ALL is one of the possible causes of persistent hypereosinophilia. In patients with ALL and hypereosinophilia, peripheral hypereosinophilia can precede the appearance of blasts. Due to the negative prognosis and the increased risk of complications in these patients, bone marrow aspiration and biopsy are recommended if common causes of secondary hypereosinophilia are excluded.
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10
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Sahu KK, Malhotra P, Khadwal A, Sachdeva MS, Sharma P, Varma N, Varma SC. Hypereosinophilia in Acute Lymphoblastic Leukemia: Two Cases with Review of Literature. Indian J Hematol Blood Transfus 2015; 31:460-5. [PMID: 26306071 PMCID: PMC4542759 DOI: 10.1007/s12288-014-0436-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Accepted: 07/10/2014] [Indexed: 01/22/2023] Open
Abstract
Eosinophilia is rare in acute leukemia at presentation. Discrete reports and case studies in recent years have created significant interest in the field of "Acute leukemia with eosinophilia". We herein present two cases of eosinophilia in association with acute lymphoblastic leukemia with brief review of literature in this field. First case is about 21-year-old female who presented with mediastinal mass along with leukocytosis and hypereosinophilia. On evaluation, she was found to have T cell acute lymphoblastic leukemia. After ruling out benign causes of eosinophilia, she was treated with modified BFM-90 protocol. Her eosinophilia resolved after 4 weeks of induction therapy. Second case is about 32-year-old male who was diagnosed as a case of mixed phenotype leukemia (B cell/myeloid type) along with severe eosinophilia. His hypereosinophilia finally resolved by week 16 of modified BFM-90 protocol. Diagnosing ALL is challenging when eosinophilia is the initial presentation. These two cases emphasize on the importance of considering ALL amongst one of the etiological causes of eosinophilia as delay in diagnosis endangers patient's life at risk. Also eosinophilia per se is an independent poor risk factor, hence prompt diagnosis and early treatment is the key in all such cases.
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Affiliation(s)
- Kamal Kant Sahu
- />Department of Clinical Hematology, Internal Medicine, PGIMER, Chandigarh, India
| | - Pankaj Malhotra
- />Department of Clinical Hematology, Internal Medicine, PGIMER, Chandigarh, India
| | - Alka Khadwal
- />Department of Clinical Hematology, Internal Medicine, PGIMER, Chandigarh, India
| | | | | | - Neelam Varma
- />Department of Hepatopathology, PGIMER, Chandigarh, India
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Goudarzipour K, Ghazizadeh F, Hoseini Tavassol H, Behnam B. Warfarin-induced Eosinophilia in a Child with urkitt Lymphoma: A Case Report. IRANIAN JOURNAL OF PHARMACEUTICAL RESEARCH : IJPR 2015; 14:887-90. [PMID: 26330877 PMCID: PMC4518117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
An important complication of chemotherapy is thromboembolic events that can occur during treatment course. In this way, Warfarin can be used as an efficient prophylactic agent to prevent these complications. Although bleeding is a common adverse effect of Warfarin, eosinophilia is a rare side effect of this drug. We have reported a 5-year-old boy with Burkitt lymphoma who underwent chemotherapy. In the course of chemotherapy, because of thrombosis of the left jugular vein, we initiated Warfarin as a prophylactic drug for TEE secondary to chemotherapy. Following Warfarin initiation, eosinophilia appeared and subsequent to cessation of drug, eosinophilia disappeared. This case is presented to point out physicians to consider eosinophilia as a rare adverse-effect of Warfarin and monitor blood cell differentiation regularly during the course of treatment with this drug.
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Affiliation(s)
- Kourosh Goudarzipour
- Pediatric Congenital Hematologic Disorders Research Center of Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Farid Ghazizadeh
- Pediatric Congenital Hematologic Disorders Research Center of Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Hesameddin Hoseini Tavassol
- Pediatric Congenital Hematologic Disorders Research Center of Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Corresponding author:
| | - Behdad Behnam
- Functional Neurosurgery Research Center, Shohada Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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12
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Parasole R, Petruzziello F, De Matteo A, Maisto G, Castelli L, Errico ME, Menna G, Poggi V. Hypereosinophilia in childhood acute lymphoblastic leukaemia at diagnosis: report of 2 cases and review of the literature. Ital J Pediatr 2014; 40:36. [PMID: 24717004 PMCID: PMC3991898 DOI: 10.1186/1824-7288-40-36] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Accepted: 04/01/2014] [Indexed: 11/10/2022] Open
Abstract
Hypereosinophilia as first clinical presentation has rarely been reported in paediatric acute lymphoblastic leukaemia. It is commonly associated with specific cytogenetic abnormalities. Although eosinophilia is considered a reactive, non-neoplastic epiphenomenon, it adversely affects patient outcomes, both in children and adults. We describe herewith two paediatric patients who had marked eosinophilia at onset of acute lymphoblastic leukaemia. We point out the importance of a correct differential diagnosis in persistent, unexplained peripheral hypereosinophilia. Clinicians should keep in mind that eosinophilia can be part of the overall pattern of acute leukaemia and therefore needs to be properly investigated. We also provide some recommendations for an appropriate approach to hypereosinophilia - related morbidities.
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Affiliation(s)
- Rosanna Parasole
- Department of Paediatric Haemato-Oncology, Santobono-Pausilipon Children's Hospital, Via Posillipo, 226, 80123 Napoli, Italy.
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