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Thomsen GN, Christoffersen MN, Lindegaard HM, Davidsen JR, Hartmeyer GN, Assing K, Mortz CG, Martin-Iguacel R, Møller MB, Kjeldsen AD, Havelund T, El Fassi D, Broesby-Olsen S, Maiborg M, Johansson SL, Andersen CL, Vestergaard H, Bjerrum OW. The multidisciplinary approach to eosinophilia. Front Oncol 2023; 13:1193730. [PMID: 37274287 PMCID: PMC10232806 DOI: 10.3389/fonc.2023.1193730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 04/25/2023] [Indexed: 06/06/2023] Open
Abstract
Eosinophilic granulocytes are normally present in low numbers in the bloodstream. Patients with an increased number of eosinophilic granulocytes in the differential count (eosinophilia) are common and can pose a clinical challenge because conditions with eosinophilia occur in all medical specialties. The diagnostic approach must be guided by a thorough medical history, supported by specific tests to guide individualized treatment. Neoplastic (primary) eosinophilia is identified by one of several unique acquired genetic causes. In contrast, reactive (secondary) eosinophilia is associated with a cytokine stimulus in a specific disease, while idiopathic eosinophilia is a diagnosis by exclusion. Rational treatment is disease-directed in secondary cases and has paved the way for targeted treatment against the driver in primary eosinophilia, whereas idiopathic cases are treated as needed by principles in eosinophilia originating from clonal drivers. The vast majority of patients are diagnosed with secondary eosinophilia and are managed by the relevant specialty-e.g., rheumatology, allergy, dermatology, gastroenterology, pulmonary medicine, hematology, or infectious disease. The overlap in symptoms and the risk of irreversible organ involvement in eosinophilia, irrespective of the cause, warrants that patients without a diagnostic clarification or who do not respond to adequate treatment should be referred to a multidisciplinary function anchored in a hematology department for evaluation. This review presents the pathophysiology, manifestations, differential diagnosis, diagnostic workup, and management of (adult) patients with eosinophilia. The purpose is to place eosinophilia in a clinical context, and therefore justify and inspire the establishment of a multidisciplinary team of experts from diagnostic and clinical specialties at the regional level to support the second opinion. The target patient population requires highly specialized laboratory analysis and therapy and occasionally has severe eosinophil-induced organ dysfunction. An added value of a centralized, clinical function is to serve as a platform for education and research to further improve the management of patients with eosinophilia. Primary and idiopathic eosinophilia are key topics in the review, which also address current research and discusses outstanding issues in the field.
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Affiliation(s)
| | | | - Hanne Merete Lindegaard
- Department of Rheumatology, Odense University Hospital, Denmark; Research Unit for Rheumatology, Odense University Hospital, Odense, Denmark; University of Southern Denmark, Odense, Denmark
| | - Jesper Rømhild Davidsen
- Department of Respiratory Medicine, Odense University Hospital, Denmark; Odense Respiratory Research Unit (ODIN), Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | | | - Kristian Assing
- Department of Clinical Immunology, Odense University Hospital, Odense, Denmark
| | - Charlotte G. Mortz
- Department of Dermatology and Allergy Centre, Odense Research Centre for Anaphylaxis (ORCA), Odense University Hospital, Denmark; University of Southern Denmark, Odense, Denmark
| | | | | | - Anette Drøhse Kjeldsen
- Department of ORL- Head and Neck Surgery and Audiology, Odense University Hospital, Odense, Denmark; University of Southern Denmark, Odense, Denmark
| | - Troels Havelund
- Department of Gastroenterology and Hepatology, Odense University Hospital, Odense, Denmark
| | - Daniel El Fassi
- Department of Hematology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Sigurd Broesby-Olsen
- Department of Dermatology and Allergy Centre, Odense Research Centre for Anaphylaxis (ORCA), Odense University Hospital, Denmark; University of Southern Denmark, Odense, Denmark
| | - Michael Maiborg
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | | | - Christen Lykkegaard Andersen
- Department of Hematology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Centre for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Hanne Vestergaard
- Department of Hematology, Odense University Hospital, Odense, Denmark
| | - Ole Weis Bjerrum
- Department of Hematology, Odense University Hospital, Odense, Denmark
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Yu JE, Sim DW, Koh YI. Etiologies and differential markers of eosinophilia-associated diseases in the Allergy Department of a single university hospital. ALLERGY ASTHMA & RESPIRATORY DISEASE 2019. [DOI: 10.4168/aard.2019.7.3.142] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- Ji Eun Yu
- Division of Allergy, Asthma, and Clinical Immunology, Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Da Woon Sim
- Division of Allergy, Asthma, and Clinical Immunology, Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Young-Il Koh
- Division of Allergy, Asthma, and Clinical Immunology, Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
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Kim HB, Seo JW, Lee JH, Choi BS, Park SG. Evaluation of the prevalence and clinical impact of toxocariasis in patients with eosinophilia of unknown origin. Korean J Intern Med 2017; 32:523-529. [PMID: 28352060 PMCID: PMC5432784 DOI: 10.3904/kjim.2014.270] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Revised: 03/22/2015] [Accepted: 06/15/2015] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND/AIMS Eosinophilia has numerous diverse causes, and in many patients, it is not possible to establish the cause of eosinophilia. Recently, toxocariasis was introduced as one cause of eosinophilia. The aims of this study were to evaluate the prevalence of toxocariasis and the clinical impact of albendazole treatment for toxocariasis in patients suspected of eosinophilia of unknown origin. METHODS We performed a retrospective chart review. After evaluation of cause of eosinophilia, the patients suspected of eosinophilia of unknown origin performed immunoglobulin G antibody specific assay for the Toxocara canis larval antigen by enzyme-linked immunosorbent assay. RESULTS This study evaluated 113 patients, 69 patients (61%) were suspected of eosinophilia of unknown origin. Among these 69 patients, the frequency of T. canis infection was very high (45 patients, 65.2%), and albendazole treatment for 45 eosinophilia with toxocariasis was highly effective for a cure of eosinophilia than no albendazole group regardless of steroid (82.3%, p = 0.007). Furthermore, among the nonsteroid treated small group (19 patients), albendazole treatment for eosinophilia were more effective than no albendazole group, too (83.3% vs. 28.6 %, p = 0.045). CONCLUSIONS The prevalence of toxocariasis was high among patients suspected of eosinophilia of unknown origin; therefore, evaluation for T. canis infection is recommended for patients with eosinophilia of unknown origin. Furthermore, for patients suspected of eosinophilia of unknown origin who have positive results for T. canis, albendazole treatment may be considered a valuable treatment option.
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Affiliation(s)
- Hong-Beum Kim
- Department of Natural Medical Sciences, Chosun University College of Health Science, Gwangju, Korea
| | - Jun-Won Seo
- Department of Internal Medicine, Chosun University Hospital, Gwangju, Korea
| | - Jun-Hyung Lee
- Department of Internal Medicine, Chosun University Hospital, Gwangju, Korea
| | - Byung-Seok Choi
- Department of Medicine, Chosun University Graduate School of Medicine, Gwangju, Korea
| | - Sang-Gon Park
- Department of Internal Medicine, Chosun University Hospital, Gwangju, Korea
- Correspondence to Sang-Gon Park, M.D. Division of HematologyOncology, Department of Internal Medicine, Chosun University Hospital, 365 Pilmun-daero, Dong-gu, Gwangju 61453, Korea Tel: +82-62-220-3984 Fax: +82-62-234-9653 E-mail:
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Kim TH, Gu HJ, Lee WI, Lee J, Yoon HJ, Park TS. Chronic eosinophilic leukemia with FIP1L1-PDGFRA rearrangement. Blood Res 2016; 51:204-206. [PMID: 27722133 PMCID: PMC5054254 DOI: 10.5045/br.2016.51.3.204] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 08/05/2015] [Accepted: 08/19/2015] [Indexed: 11/28/2022] Open
Affiliation(s)
- Tae Hee Kim
- Department of Laboratory Medicine, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Hyun Jung Gu
- Department of Laboratory Medicine, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Woo-In Lee
- Department of Laboratory Medicine, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Juhie Lee
- Department of Pathology, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Hwi-Joong Yoon
- Department of Hematology-Oncology, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Tae Sung Park
- Department of Laboratory Medicine, School of Medicine, Kyung Hee University, Seoul, Korea
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Shin SY, Jung CW, Choi DC, Lee BJ, Kim HJ, Kim SH. Chronic eosinophilic leukemia with a FIP1L1-PDGFRA rearrangement: Two case reports and a review of Korean cases. Blood Res 2015; 50:58-61. [PMID: 25830134 PMCID: PMC4377343 DOI: 10.5045/br.2015.50.1.58] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Revised: 08/05/2014] [Accepted: 02/12/2015] [Indexed: 11/22/2022] Open
Affiliation(s)
- Sang-Yong Shin
- Department of Laboratory Medicine & Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Chul-Won Jung
- Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dong-Chull Choi
- Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Byung-Jae Lee
- Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hee-Jin Kim
- Department of Laboratory Medicine & Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sun-Hee Kim
- Department of Laboratory Medicine & Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Kim KM, Bae MH, Kim YM, Cho MJ, Kwak MJ, Kim SH, Son SK, Park HJ, Kim HY. Cause and incidence of eosinophilia in children: a single center study in one year. ALLERGY ASTHMA & RESPIRATORY DISEASE 2014. [DOI: 10.4168/aard.2014.2.5.358] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Kyung-Min Kim
- Department of Pediatrics, Pusan National University School of Medicine, Busan, Korea
| | - Mi-Hye Bae
- Department of Pediatrics, Pusan National University School of Medicine, Busan, Korea
| | - Young-Mi Kim
- Department of Pediatrics, Pusan National University School of Medicine, Busan, Korea
| | - Min-Jung Cho
- Department of Pediatrics, Pusan National University School of Medicine, Busan, Korea
| | - Min-Jung Kwak
- Department of Pediatrics, Pusan National University School of Medicine, Busan, Korea
| | - Seong-Heon Kim
- Department of Pediatrics, Pusan National University School of Medicine, Busan, Korea
| | - Seung-Kook Son
- Department of Pediatrics, Pusan National University School of Medicine, Busan, Korea
| | - Hee-Ju Park
- Department of Pediatrics, Pusan National University School of Medicine, Busan, Korea
| | - Hye-Young Kim
- Department of Pediatrics, Pusan National University School of Medicine, Busan, Korea
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Lim JH. Foodborne eosinophilia due to visceral larva migrans: a disease abandoned. J Korean Med Sci 2012; 27:1-2. [PMID: 22219605 PMCID: PMC3247763 DOI: 10.3346/jkms.2012.27.1.1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2011] [Accepted: 10/11/2011] [Indexed: 11/26/2022] Open
Affiliation(s)
- Jae Hoon Lim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Lee HS, Park LC, Shin SH, Lee SU, Chang HK, Huh B, Jung GS, Kim MH, Kim YS. Successful Chemotherapy Following Autologous Stem Cell Transplantation in Multiple Myeloma and Multi-organ Dysfunction with Infiltration of Eosinophils: A Case Report. Cancer Res Treat 2011; 43:199-203. [PMID: 22022299 PMCID: PMC3192883 DOI: 10.4143/crt.2011.43.3.199] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2010] [Accepted: 09/27/2010] [Indexed: 12/04/2022] Open
Abstract
Eosinophils are derived from hematopoietic stem cells. Peripheral blood eosinophilia is defined as an absolute eosinophil count of ≥0.5×109/L. Eosinophilia is classified into primary or clonal eosinophilia, secondary eosinophilia, and idiopathic categories including idiopathic hypereosinophilic syndrome. Both hematopoietic and solid neoplasms may be associated with peripheral blood eosinophilia, but multiple myeloma is rarely associated with eosinophilia. We now report the case of a 31-year-old man with multiple myeloma associated with marked eosinophilia who developed multiple organ dysfunction with infiltration of eosinophils. He recovered after treatment with chemotherapy followed by autologous stem cell transplantation.
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Affiliation(s)
- Ho Sup Lee
- Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea
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