Abbass Mortada, Joudi Lana, Khalifeh Haidar, Almasri Hussein, Dhayni Raghida
Faculty of Medicine, Beirut Arab University, Beirut, Lebanon.
Kharkiv National Medical University,Kharkiv, Ukraine.
Ann Med Surg (Lond). 2025 Apr 4;87(5):3023-3026. doi: 10.1097/MS9.0000000000003240. eCollection 2025 May.
The differential diagnoses of hypereosinophilia (HE) are diverse and may include parasitic infections, allergic or atopic diseases, and malignancies. The list of differentials for hypereosinophilia is diverse and a comprehensive workup can often be expensive. However, it is essential to identify the underlying cause and treat it rather than treating eosinophilia itself.
A 5-year-old male patient was referred to a pediatric hemato-oncologist for concerns of persistent hypereosinophilia, and the absolute eosinophil count (AEC) was greater than 1000 in three recent complete blood count with differentials. The child presented complaining of alternating waxing and waning right and left ankle and knee redness, hotness, pain, and decreased range of motion that occurred every 2 weeks, with associated lack of appetite, fatigue, constipation, and fever reaching 39°C.
Malignant eosinophilic infiltration of the bone marrow versus a parasitic infection was on top of the differential diagnoses. Presentations of HE suggesting organ system involvement include fever, weight loss, wheezing, cough, dysphagia, vomiting, lack of appetite, diarrhea, arthralgia, and myalgia.
Identifying the etiology of persistent hypereosinophilia can be challenging in the pediatric population and can have diverse presentations. The primary focus during initial HE assessment is on evaluating the severity of symptoms and potential organ damage. Major life-threatening diagnoses as malignancies and immune deficiencies must be ruled out first when the AEC is persistently elevated. Parasitic infections should be investigated according to the geographic endemicity.
嗜酸性粒细胞增多症（HE）的鉴别诊断多种多样，可能包括寄生虫感染、过敏性或特应性疾病以及恶性肿瘤。嗜酸性粒细胞增多症的鉴别诊断范围广泛，全面的检查通常费用高昂。然而，识别潜在病因并进行治疗至关重要，而非仅仅治疗嗜酸性粒细胞增多本身。
一名5岁男性患者因持续性嗜酸性粒细胞增多症被转诊至儿科血液肿瘤学家处，近期三次不同的全血细胞计数中绝对嗜酸性粒细胞计数（AEC）均大于1000。患儿主诉左右脚踝和膝盖交替出现红肿、发热、疼痛以及活动范围减小，每2周发作一次，伴有食欲不振、疲劳、便秘以及体温高达39°C的发热症状。
骨髓恶性嗜酸性粒细胞浸润与寄生虫感染位列鉴别诊断之首。提示器官系统受累的嗜酸性粒细胞增多症表现包括发热、体重减轻、喘息、咳嗽、吞咽困难、呕吐、食欲不振、腹泻、关节痛和肌痛。
在儿科人群中，识别持续性嗜酸性粒细胞增多症的病因具有挑战性，且可能有多种表现形式。嗜酸性粒细胞增多症初始评估的主要重点是评估症状的严重程度和潜在的器官损害。当AEC持续升高时，必须首先排除恶性肿瘤和免疫缺陷等主要危及生命的诊断。应根据地理流行情况调查寄生虫感染。
