eosinophilia and lung disorders

The most common eosinophilic lung disorders are asthma and COPD with eosinophilia. These patients usually have normal chest xray and no fever.

If a patient has asthma like symptoms with skin or eye involvement (mononeuritis multiplex) or foot drop, one should consider EGPA (eosinophilic granulomatosis with polyangitis aka churg strauss). EGPA will also have migratory pulmonary infiltrates.

If a patient has recurrent hospitalizations for pneumonia, differential should include eosinophilic pneumonia (acute and chronic eosinophilic pneumonia AEP and CEP). Fever, cough, and abnormal chest xray are first clues. diagnostic criteria for acute eosinophilic pneumonia.

Patients with CF, asthma, and severe COPD should be considered for APBA (Allergic bronchopulmonary aspergillosis ABPA), especially if they have characteristic chest imaging (ABPA image findings include central, asymmetric bronchiectasis, bronchial wall thickening, and mucoid impaction.

A rare condition called hypereosinophilic obliterative bronchiolitis should be considered if there's characteristic signs of bronchiolitis on HRCT.

Infections as result of Loffler's syndrome should be considered.

Parasitic infections can cause eosinophilia (pulmonary echinococcosis can present with pneumothorax).

Lastly, drugs and toxins can cause high eosinophils. These include NSAIDS, antibiotics (e.g. nitrofurantoin, minocycline, daptomycin), dupixent (dupilumab dupixent can have transient elevation in blood eosinophils) 1

Footnotes

  1. Association of Pulmonary and Critical Care Medicine Program Directors ↩