Disorders associated with marked eosinophilia
| Category . | Examples . | Comments . |
|---|---|---|
| Atopic disorders | Asthma; atopic dermatitis; chronic rhinosinusitis | Typically cause mild to moderate eosinophilia |
| Drug hypersensitivity | Varied; drug rash, eosinophilia, and systemic symptoms; eosinophilia-myalgia syndrome | Can occur with any drug or supplement; manifestations range from asymptomatic eosinophilia to life-threatening complications40 |
| Infection and infestation | Helminth infection (especially those with a tissue invasive phase) Fungal infections Viral infection (HIV, COVID-19) Ectoparasite infestation Protozoal infection (limited to Sarcocystis and Cystoisospora) Tuberculosis (rare) | Most common etiology worldwide; Strongyloides infection should always be considered due to worldwide distribution and the potential for fatal dissemination with steroid therapy41 |
| Autoimmune and immunodysregulatory disorders | Inflammatory bowel disease, sarcoidosis, IgG4 disease | Clinical sequelae of eosinophilia may or may not be present and can be difficult to distinguish from the manifestations of the underlying disorder |
| Neoplasia | Leukemia, lymphoma, solid tumors (especially adenocarcinoma) | Although any leukemia/lymphoma can present with HE/HES, pre–B-cell acute lymphoblastic leukemia can be particularly difficult to diagnose |
| Inborn errors of immunity | Omenn syndrome, DOCK8 deficiency, Loeys-Dietz syndrome | Usually diagnosed in childhood, recurrent or unusual infections common42 |
| Rare hypereosinophilic syndromes | Eosinophilic myeloid neoplasms, lymphocytic variant HE/HES, idiopathic HE/HES, familial HE/HES, single-organ HE/HES, and other overlap disorders | See Figure 2 for additional details |
| Other | Radiation, hypoadrenalism, cholesterol emboli, administration of IL-2 |
| Category . | Examples . | Comments . |
|---|---|---|
| Atopic disorders | Asthma; atopic dermatitis; chronic rhinosinusitis | Typically cause mild to moderate eosinophilia |
| Drug hypersensitivity | Varied; drug rash, eosinophilia, and systemic symptoms; eosinophilia-myalgia syndrome | Can occur with any drug or supplement; manifestations range from asymptomatic eosinophilia to life-threatening complications40 |
| Infection and infestation | Helminth infection (especially those with a tissue invasive phase) Fungal infections Viral infection (HIV, COVID-19) Ectoparasite infestation Protozoal infection (limited to Sarcocystis and Cystoisospora) Tuberculosis (rare) | Most common etiology worldwide; Strongyloides infection should always be considered due to worldwide distribution and the potential for fatal dissemination with steroid therapy41 |
| Autoimmune and immunodysregulatory disorders | Inflammatory bowel disease, sarcoidosis, IgG4 disease | Clinical sequelae of eosinophilia may or may not be present and can be difficult to distinguish from the manifestations of the underlying disorder |
| Neoplasia | Leukemia, lymphoma, solid tumors (especially adenocarcinoma) | Although any leukemia/lymphoma can present with HE/HES, pre–B-cell acute lymphoblastic leukemia can be particularly difficult to diagnose |
| Inborn errors of immunity | Omenn syndrome, DOCK8 deficiency, Loeys-Dietz syndrome | Usually diagnosed in childhood, recurrent or unusual infections common42 |
| Rare hypereosinophilic syndromes | Eosinophilic myeloid neoplasms, lymphocytic variant HE/HES, idiopathic HE/HES, familial HE/HES, single-organ HE/HES, and other overlap disorders | See Figure 2 for additional details |
| Other | Radiation, hypoadrenalism, cholesterol emboli, administration of IL-2 |
COVID-19, coronavirus disease 2019; HIV, human immunodeficiency virus.