Kimura's disease is a rare, benign, slow-growing chronic inflammatory swelling with a predilection for the head and neck region and is almost always with peripheral blood eosinophilia and elevated serum IgE levels. It is endemic in Asian males and rare in Western people. Surgical excision of the lesion is the first line therapy. Drug and radiation therapy have to be considered for the refractory lesions.
Angiolymphoid Hyperplasia with Eosinophilia ; diagnosis ; Asian Continental Ancestry Group ; Eosinophilia ; pathology ; Humans ; Immunoglobulin E ; blood ; Inflammation ; pathology ; Male ; Neck ; pathology

Eosinophilic myocarditis usually results from myocardial damage as a result of drugs or parasites, and is generally associated with increased peripheral eosinophil count. This form of myocarditis is difficult to diagnose clinically. A 25 year-old previously healthy woman was transferred from a local clinic because of hypotension and dyspnea with sudden cardiogenic shock after a three day history of gastrointestinal illness. Echocardiography revealed concentric left ventricular wall thickening with moderate pericardial effusion. Biopsy of endomyocardial tissue from the right ventricle showed diffuse infiltration of inflammatory cells, mostly eosinophils, even though the patient had a peripheral eosinophil count that was normal at the time of biopsy. The patient was treated with corticosteroids for the symptoms of pericarditis, and she recovered without cardiac sequelae, clinically and echocardiographically. We here report a case of acute eosinophilic myopericarditis, with cardiogenic shock, diagnosed by endomyocardial biopsy with normal peripheral eosinophil count at the time of biopsy, and complete recovery without sequelae.
Shock, Cardiogenic/blood/*etiology ; Pericarditis/blood/*diagnosis ; Myocarditis/blood/*diagnosis ; Leukocyte Count ; Humans ; Female ; *Eosinophils ; Eosinophilia/blood/*diagnosis ; Adult ; Acute Disease

PURPOSE: The authors of the present study describe a rare case of angiolymphoid hyperplasia with eosinophilia (ALHE) of the eyelid. CASE SUMMARY: A 63-year-old male who was diagnosed with ALHE based on biopsy of an inguinal mass presented with an eyelid mass of 1 month duration. A light brown, solitary, 1.0 x 0.5 cm-sized mass involved the right upper eyelid. There was no lymphadenopathy, but eosinophilia was present. An excisional biopsy of the mass was performed for diagnosis and management. Macroscopic examination of the excised mass revealed a well-defined, smooth, firm, yellowish-red colored lesion measuring 1.0 x 0.6 x 0.5 cm. Histopathology showed the proliferation of small blood vessels, many of which were lined by enlarged endothelial cells with uniform ovoid nuclei and intracytoplasmic vacuoles. The distinctive endothelial cells were described as having a cobblestone appearance. In addition, a perivascular and interstitial infiltrate composed primarily of lymphocytes and eosinophils was present. ALHE was finally confirmed with clinical and microscopic examination. CONCLUSIONS: The authors of the present study report a rare case of ALHE of the eyelid and suggest that a differential diagnosis should be considered.
Angiolymphoid Hyperplasia with Eosinophilia ; Biopsy ; Blood Vessels ; Diagnosis, Differential ; Endothelial Cells ; Eosinophilia ; Eosinophils ; Eyelids ; Humans ; Light ; Lymphatic Diseases ; Lymphocytes ; Male ; Middle Aged ; Vacuoles

BACKGROUND: Erythroderma may result from different causes. Almost all the published original clinical series of erythroderma originated from western countries. OBJECTIVES: The objective was to evaluate various causes of erythroderma in our environment, frequency, clinical and laboratory findings, and patient evolution. METHOD: We reviewed the clinical and laboratory findings including biopsy materials of 39 patients diagnosed as erythroderma and treated during the last 9 years (from 1989 to 1998). RESULTS: The male-female ratio was 3 to 1. The mean age at diagnosis was 54 years. Drug reaction and undetermined cause were the most frequent cause (30.8%, respectively), followed by the pre-existing dermatoses (28.2%), and malignancies (10.3%). Elevated erythrocyte sedimentation rate was found in 70.4% of the patients. Eight patients were resistant to treatment. In the patients with the persistent erythroderma, leukocytosis, elevated erythrocyte sedimentation rate, and eosinophilia were the common findings. CONCLUSIONS: Half of the patients with the erythroderma of undetermined cause showed the protracted course. Two patients diagnosed as cutaneous T-cell lymphoma and S zary syndrome had the history of generalized erythroderma of more than 3 years. The close follow-up for the erythroderma of undetermined cause with frequent laboratory and histopathological evaluations would be mandatory.
Biopsy ; Blood Sedimentation ; Dermatitis, Exfoliative* ; Diagnosis ; Eosinophilia ; Follow-Up Studies ; Humans ; Leukocytosis ; Lymphoma, T-Cell, Cutaneous ; Skin Diseases

Animals ; Antibodies, Helminth ; blood ; cerebrospinal fluid ; Child, Preschool ; Eosinophilia ; cerebrospinal fluid ; diagnosis ; etiology ; Female ; Humans ; Meningitis ; cerebrospinal fluid ; diagnosis ; etiology ; Neurocysticercosis ; complications ; drug therapy ; parasitology ; Taenia ; immunology

OBJECTIVETo explore the role of eotaxin in the pathogenesis of bronchial asthma and the clinical value in the diagnosis of asthma.

METHODSSerum eotaxin were measured by ELISA in 38 patients with asthma, 28 patients with non-asthma allergy, and 30 healthy controls.

RESULTSThe levels of serum eotaxin in the asthma group were higher than those in the non-asthma allergic and control group (P<0.01). Furthermore, eotaxin levels in patients with acute asthma were significantly higher than those in patients with stable asthma (P<0.001). It was also found that the eotaxin levels of the acute asthma group were positively correlated to the amounts of eosinophils in peripheral blood (r=0.4196, P<0.001), and inversely correlated to the forced expiratory volume in one second (FEV1) (r=-0.3746, P<0.001).

CONCLUSIONIt suggests that eotaxin may play a crucial pathogenic role in the asthmatic process possibly by activating the allergic inflammatory cells and controlling the recruitment of eosinophils from blood to bronchial epithelium of the airway. The concentration of eotaxin is significantly associated with the attack of acute asthma and its severity. Eotaxin may be a potential therapeutic target in patients with asthma.

Adult ; Asthma ; diagnosis ; physiopathology ; Cell Count ; Chemokine CCL11 ; Chemokines, CC ; blood ; physiology ; Eosinophilia ; pathology ; Female ; Forced Expiratory Volume ; Humans ; Male ; Middle Aged

Toxocariasis is one of the causes of pulmonary eosinophilic infiltrate that is increasing in Korea. This study was designed to identify the prevalence of toxocara seropositivity in patients with unexplained pulmonary patchy infiltrate and to evaluate associated factors. We evaluated 102 patients with unexplained pulmonary patchy infiltrate on chest computed tomography (CT) scan. As a control set, 116 subjects with normal chest CT were also evaluated. History of allergic disease, drug use, parasitic disease and raw cow liver intake were taken. Blood eosinophil count and total IgE level were measured. Specific serum IgG antibody to Toxocara canis larval antigen and specific IgG antibodies to 4 other parasites were measured by enzymelinked immunosorbent assay (ELISA). In the infiltrate group, 66.7% subjects were toxocara seropositive whereas 22.4% of the control group were seropositive (p< 0.001). In the infiltrate group, patients with a history of eating raw cow liver (odds ratio [OR], 7.8) and patients with eosinophilia (OR, 5.2) had a higher incidence of toxocara seropositivity. Thirty-five percent of toxocara seropositive patients with infiltrate exhibited migrating infiltrate and 48% had decreased infiltrate on the follow- up CT. We recommend that toxocara ELISA should be performed in patients with unexplained pulmonary patchy infiltrate, and that the eating of raw cow liver should be actively discouraged.
Adult ; Aged ; Animals ; Case-Control Studies ; Female ; Humans ; Immunoglobulin E/blood ; Korea ; Leukocyte Count ; Liver/parasitology ; Male ; Middle Aged ; Pulmonary Eosinophilia/diagnosis/*etiology/immunology ; Seroepidemiologic Studies ; Tomography, X-Ray Computed ; Toxocara/immunology ; Toxocariasis/*complications/diagnosis/epidemiology

Churg-Strauss syndrome (CSS) is a rare systemic vasculitis that affect small and medium-sized blood vessels and is accompanied by asthma, eosinophilia, and peripheral neuropathy. This report describes a case of a 52-year-old man who had a history of sinusitis, asthma, and thymus cancer and who had complained of bilateral lower extremity paresthesia and weakness for a month. Peripheral neuropathy was detected by electrodiagnostic studies. Resection of a mediastinal mass, which was diagnosed as thymic neuroendocrine carcinoma, was performed five months before his visit. After thymectomy, peripheral blood tests revealed a gradual increase in eosinophils. Two months after surgery, he was admitted to the hospital for dyspnea, and nodules of focal consolidation were found in his chest X-ray. One month later, pyoderma occurred in the right shin, and the skin biopsy showed extravascular eosinophilic infiltration. He was diagnosed with CSS after thymectomy, and we report a very rare case of CSS presented with thymic neuroendocrine carcinoma.
Asthma ; Biopsy ; Blood Vessels ; Carcinoma, Neuroendocrine* ; Churg-Strauss Syndrome* ; Diagnosis* ; Dyspnea ; Eosinophilia ; Eosinophils ; Hematologic Tests ; Humans ; Lower Extremity ; Middle Aged ; Paresthesia ; Peripheral Nervous System Diseases ; Polyneuropathies ; Pyoderma ; Sinusitis ; Skin ; Systemic Vasculitis ; Thorax ; Thymectomy ; Thymus Neoplasms

BACKGROUND: The hypereosinophilic syndrome(HES) represents a leukoproliferative process likely caused by a number of disorders, all of which are marked by sustained over-production of eosinophils. OBJECTIVES: The purposes of this study were aimed at evaluating the clinical and histopathological characteristics of HES. METHODS: The medical records and hist opathological slides of patients with HES who had skin biopsies performed in our department were reviewed. Criteria for the diagnosis of HES include (1) peripheral blood eosinophilia with eosinophil counts greater than 1,500/L for at least 6 months; (2) no evidence of parasitic, allergic, or other known causes of eosinophilia; and (3) presumptive signs and symptoms of multiple organ involvement. RESULTS: Four male and three female patients were included. HES developed in adulthood or old age (mean, 43.4 years). Because only the patients with cutaneous involvement were included, all the patients showed skin lesions. Heart, liver, stomach, nervous system, lymph nodes, and lung were involved organs in decreasing order of frequency. At the onset of HES, 40 to 80% of white blood cells were eosinophils in peripheral blood. White blood cell count and serum IgE level were elevated in all the tested patients. In six patients (85.7%), the level of serum erythrocyte sedimentation rate was elevated. Persistent hypereosinophilia (>1,500/L) was present for longer than 6 months in all patients. Stool examination and skin test for parasitic infestation all gave negative results. All the patients were not taking any medication. Histopathological examinations revealed perivascular mixed inflammatory cell infiltration; predominantly eosinophils in the stomach, liver, and nerve as well as in the skin. Interestingly, two patients who were presented with skin lesions showed the findings of eosinophilic vasculitis. In these patients, the skin lesions were consisted of Raynaud's phenomenon, digital gangrene, and several erythematous plaques. The most common cutaneous manifestations were papules and nodules on the extremities. The main treatment modality was systemic steroid. Except for one patient presented with central nervous system involvement of HES, all the patients were in a well-controlled state. In one patient with the typical clinical and hematologic features of HES, Hodgkin's disease followed. After the complete remission of Hodgkin's disease with chemotherapy, HES subsided. CONCLUSIONS: HES is a heterogenous collection of disorders marked by hypereosinophilia and organ damage. Most common cutaneous manifestations were papules and nodules on the extremities. Raynaud's phenomenon and digital gangrene can be the primary manifestation of HES in which cases cutaneous lesions showed eosinophilic vasculitis. Five patients (71%) responded well to systemic steroids. HES may be a herald of malignancy such as Hodgkin's disease. Further investigation will be mandatory ro elucidate the etiology and pathogenesis of HES.
Biopsy ; Blood Sedimentation ; Central Nervous System ; Diagnosis ; Drug Therapy ; Eosinophilia ; Eosinophils ; Extremities ; Female ; Gangrene ; Heart ; Hodgkin Disease ; Humans ; Hypereosinophilic Syndrome* ; Immunoglobulin E ; Leukocyte Count ; Leukocytes ; Liver ; Lung ; Lymph Nodes ; Male ; Medical Records ; Nervous System ; Skin ; Skin Tests ; Steroids ; Stomach ; Vasculitis

Allopurinol, a commonly prescribed medicine for the management of gout and hyperuricemia, may induce life-threatening hypersensitivity characterized by fever, eosinophilia, hepatitis, renal failure, and skin eruptions such as Stevens-Johnson syndrome or toxic epidermal necrolysis. Stevens-Johnson syndrome may rarely affect the gastrointestinal tract, associated with a poor prognosis. We have experienced a patient having allopurinol hypersensitivity syndrome (AHS) with esophageal ulcer bleeding. A 64-year-old man was admitted with ten-day history of widespread rash and fever. Six weeks before admission, he had symptoms of gouty arthritis, and he was treated with allopurinol and colchicine for 10 days. Complete blood count showed leukocytosis with eosinophilia and blood biochemistry showed impaired renal and hepatic function. The diagnosis of an AHS with Stevens-Johnson syndrome was made from the history and the typical clinical feature. Despite adequate hydration, steroid and immunoglobulin therapy, severe esophageal ulcer bleeding, sepsis and disseminated intravascular coagulation had been developed and the patient died 33 days after admission. Until now, there is no specific treatment for the AHS. The only means of minimizing the incidence of AHS is to limit the allopurinol therapy to accepted indications and to adjust the dosage for the patient's renal function.
Allopurinol* ; Arthritis, Gouty ; Biochemistry ; Blood Cell Count ; Colchicine ; Diagnosis ; Disseminated Intravascular Coagulation ; Eosinophilia ; Exanthema ; Fever ; Gastrointestinal Tract ; Gout ; Hemorrhage* ; Hepatitis ; Humans ; Hypersensitivity* ; Hyperuricemia ; Immunization, Passive ; Incidence ; Leukocytosis ; Middle Aged ; Prognosis ; Renal Insufficiency ; Sepsis ; Skin ; Stevens-Johnson Syndrome ; Ulcer*