Hypereosinophilic Syndrome Differential Diagnoses

Sections

DDx

Diagnostic Considerations

Other problems to be considered in the differential diagnosis of hypereosinophilic syndrome include the following:

Allergic diseases
Angiolymphoid hyperplasia with eosinophilia
Collagen vascular diseases
Atopic dermatitisc
Drug reactions
Eosinophilic toxocariasis
Eosinophilic pneumonia
Episodic angioedema with eosinophilia
Hypersensitivity diseases
Malignancy with secondary eosinophilia (eg, Hodgkin disease, acute myeloid leukemia M4 with bone marrow eosinophilia [AML-M4EO])
Parasitic infections

To elicit a history of parasitic infection, the clinician should question the patient regarding travel, immigration, or foreign service at any time in the past. Notably, Strongyloides stercoralis, which is is endemic in tropical and subtropical climates, can propagate itself internally and cause eosinophilia several decades after initial infection.^[22]

The medication history should include prescription drugs, over-the-counter medications, herbal compounds, and nutritional supplement. Clinical suspicion should extend to agents in long-term use, as drug-induced eosinophilia may develop months and even years after initiation of therapy.^[22]

Some types of medications are more likely to cause an eosinophilic drug reaction; these include anticonvulsants, semisynthetic penicillins, and allopurinol. Although drug-induced eosinophilia may develop without other manifestations, such as rashes or fever, certain patterns tend to occur with specific drugs, as follows^[22]:

Hepatitis or DRESS syndrome (drug-induced rash, eosinophilia, and systemic symptoms) – Anticonvulsants
Pneumonitis – Nitrofurantoin, semisynthetic penicillins, non-steroidal anti-inflammatory drugs
Nephritis – Cephalosporins
Hypersensitivity vasculitis – Allopurinol, phenytoin

Differential Diagnoses

Workup

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Media Gallery

Indurated edematous plaques of hypereosinophilic syndrome on a patient's legs.
Erythroderma in a patient with hypereosinophilic syndrome.

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Author

Venkata Anuradha Samavedi, MBBS, MD Internist in Houston, TX

Disclosure: Nothing to disclose.

Coauthor(s)

Ronald A Sacher, MB, BCh, FRCPC, DTM&H Professor, Internal Medicine and Pathology, Director, Hoxworth Blood Center, University of Cincinnati Academic Health Center

Ronald A Sacher, MB, BCh, FRCPC, DTM&H is a member of the following medical societies: American Association for the Advancement of Science, American Association of Blood Banks, American Clinical and Climatological Association, American Society for Clinical Pathology, American Society of Hematology, College of American Pathologists, International Society of Blood Transfusion, International Society on Thrombosis and Haemostasis, Royal College of Physicians and Surgeons of Canada

Disclosure: Serve(d) as a speaker or a member of a speakers bureau for: GSK Pharmaceuticals,Alexion,Johnson & Johnson Talecris,Grifols, BMS<br/>May receive honoraria from the above companies for speaking and teaching.

Vincent E Herrin, MD, FACP Professor of Medicine, Division of Hematology and Medical Oncology, Director, Medicine Residency Program, University of Mississippi School of Medicine

Vincent E Herrin, MD, FACP is a member of the following medical societies: American College of Physicians, American College of Physicians-American Society of Internal Medicine, American Society of Clinical Oncology, Southern Society for Clinical Investigation, American Society of Hematology

Disclosure: Nothing to disclose.

Joe C Files, MD Director, Division of Hematology, Associate Chairman, Professor, Department of Internal Medicine, University of Mississippi Medical Center

Joe C Files, MD is a member of the following medical societies: American Association for the Advancement of Science, American Association for Cancer Education, American College of Physicians, American Federation for Medical Research, American Heart Association, American Medical Association, American Society of Human Genetics, Mississippi State Medical Association, New York Academy of Sciences, Southern Medical Association

Disclosure: Nothing to disclose.

Youwen Zhou, MD, PhD, FRCPC Associate Professor, Department of Dermatology and Skin Science, University of British Columbia Faculty of Medicine; Director, Hyperhidrosis Specialty Clinic, Co-Director, Psoriasis and Phototherapy Centre, Consulting Physician, Department of Dermatology, Vancouver General Hospital; Co-Director, Vitiligo and Pigmentation Clinic, Oncologist Consultant, Skin Tumor Program, BC Cancer Agency

Youwen Zhou, MD, PhD, FRCPC is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Paul Schick, MD Emeritus Professor, Department of Internal Medicine, Jefferson Medical College of Thomas Jefferson University; Research Professor, Department of Internal Medicine, Drexel University College of Medicine; Adjunct Professor of Medicine, Lankenau Hospital

Paul Schick, MD is a member of the following medical societies: American College of Physicians, American Society of Hematology

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Emmanuel C Besa, MD Professor Emeritus, Department of Medicine, Division of Hematologic Malignancies and Hematopoietic Stem Cell Transplantation, Kimmel Cancer Center, Jefferson Medical College of Thomas Jefferson University

Emmanuel C Besa, MD is a member of the following medical societies: American Association for Cancer Education, American Society of Clinical Oncology, American College of Clinical Pharmacology, American Federation for Medical Research, American Society of Hematology, New York Academy of Sciences

Disclosure: Nothing to disclose.

Additional Contributors

Antoni Ribas, MD Assistant Professor of Medicine, Division of Hematology-Oncology, University of California at Los Angeles Medical Center

Disclosure: Nothing to disclose.

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