Differential diagnosis of hypereosinophilia
| Category . | Examples (not inclusive) . |
|---|---|
| Allergic disorders* | Asthma, atopic dermatitis |
| Drug hypersensitivity | Varied† |
| Infection | |
| Helminthic | Varied, including strongyloidiasis, trichinellosis, filariasis, schistosomiasis, hookworm |
| Ectoparasite | Scabies, myiasis |
| Protozoan | Isosporiasis, sarcocystis myositis |
| Fungal | Coccidiomycosis, allergic bronchopulmonary aspergillosis, histoplasmosis |
| Viral | HIV |
| Neoplasms | Leukemia, lymphoma, adenocarcinoma |
| Immunologic disorders‡ | |
| Immunodeficiency | DOCK8 deficiency, Hyper-IgE syndrome, Omenn’s syndrome |
| Autoimmune and idiopathic | Sarcoidosis, inflammatory bowel disease, IgG4 disease, and other connective tissue disorders |
| Miscellaneous | Radiation exposure, cholesterol emboli, hypoadrenalism, IL-2 therapy |
| Rare eosinophilic disorders | Idiopathic hypereosinophilic syndrome, eosinophilic granulomatosis with polyangiitis (formerly Churg-Strauss syndrome), eosinophilic gastrointestinal disorders |
| Category . | Examples (not inclusive) . |
|---|---|
| Allergic disorders* | Asthma, atopic dermatitis |
| Drug hypersensitivity | Varied† |
| Infection | |
| Helminthic | Varied, including strongyloidiasis, trichinellosis, filariasis, schistosomiasis, hookworm |
| Ectoparasite | Scabies, myiasis |
| Protozoan | Isosporiasis, sarcocystis myositis |
| Fungal | Coccidiomycosis, allergic bronchopulmonary aspergillosis, histoplasmosis |
| Viral | HIV |
| Neoplasms | Leukemia, lymphoma, adenocarcinoma |
| Immunologic disorders‡ | |
| Immunodeficiency | DOCK8 deficiency, Hyper-IgE syndrome, Omenn’s syndrome |
| Autoimmune and idiopathic | Sarcoidosis, inflammatory bowel disease, IgG4 disease, and other connective tissue disorders |
| Miscellaneous | Radiation exposure, cholesterol emboli, hypoadrenalism, IL-2 therapy |
| Rare eosinophilic disorders | Idiopathic hypereosinophilic syndrome, eosinophilic granulomatosis with polyangiitis (formerly Churg-Strauss syndrome), eosinophilic gastrointestinal disorders |
Allergic disorders, including asthma and atopic dermatitis, can be associated with HE (AEC ≥1.5 × 109/L), especially in children, although extremely high eosinophil counts (AEC ≥5.0 × 109/L) should prompt consideration of another cause. Because allergic manifestations are common in patients with idiopathic HES and L-HES, the distinction between allergic disease with marked eosinophilia and HES with concomitant allergic disease may be impossible in some cases.
Drug hypersensitivity can occur in response to any prescription or nonprescription drug or supplement. Although drug-associated eosinophilia can be asymptomatic, well-described syndromes include eosinophilia-myalgia syndrome, drug reaction with eosinophilia and systemic symptoms, interstitial nephritis, and eosinophilic hepatitis.
HE can occur in the setting of a wide variety of immunologic disorders, particularly those characterized by dysregulation of lymphocyte proliferation or function. Signs and symptoms attributable to the eosinophilia may or may not be present and can be difficult at times to distinguish from manifestations of the underlying disorder.