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BACKGROUND: Drug reaction with eosinophilia and systemic symptoms is a severe form of drug-induced reaction with multiorgan involvement. OBJECTIVES: The aim of this study is to evaluate the epidemiological, clinical and pathological features and prognosis of this drug reaction among patients seen at a dermatology service. METHOD: Retrospective review of medical records of ten patients diagnosed with drug reaction with eosinophilia and systemic symptoms at the Federal University of São Paulo, from august 2008 to may 2011. RESULTS: Phenytoin was the leading cause of drug reaction with eosinophilia and systemic symptoms in our cases, followed by allopurinol. Abnormal liver function tests were observed in 7 patients and renal function impairment in 2 patients. In all cases, patients were hospitalized and the culprit drug was withdrawn. The main treatment was systemic corticosteroid. Drug reaction with eosinophilia and systemic symptoms resulted in death in 2 cases. The causes of death were septic shock and hepatic failure. CONCLUSION: Our mortality rate of 20%, supports that drug reaction with eosinophilia and systemic symptoms is a severe form of drug-induced reaction and must be recognized by all dermatologists.FUNDAMENTOS: A reação a droga com eosinofilia e sintomas sistêmicos é uma reação medicamentosa severa com envolvimento de múltiplos órgãos. OBJETIVO: Avaliar as características epidemiológicas, clínicas, histológicas e o prognóstico dessa reação medicamentosa entre os pacientes atendidos pelo serviço da dermatologia. MÉTODOS: Levantamento retrospectivo dos prontuários de dez pacientes diagnosticados com reação a droga com eosinofilia e sintomas sistêmicos pelo serviço de dermatologia da Universidade Federal de São Paulo, entre agosto de 2008 e maio de 2011. RESULTADOS: A fenitoína foi a principal causa de reação a droga com eosinofilia e sintomas sistêmicos entre os pacientes, seguida pelo alopurinol. A alteração das enzimas hepáticas foi observada em sete pacientes e diminuição da função renal em dois casos. Todos os pacientes estavam hospitalizados e o medicamento implicado foi suspenso. O principal tratamento foi corticóide sistêmico. Dois pacientes faleceram devido à síndrome reação a droga com eosinofilia e sintomas sistêmicos. A causa da morte foi choque séptico e falência hepática. CONCLUSÃO: A mortalidade de 20% entre os pacientes do estudo confirma que essa reação induzida por droga é grave e deve ser reconhecida por todos os dermatologistas.

The Drug Reaction with Eosinophilia and Systemic Symptoms syndrome, also known as Drug Induced Hypersensitivity Syndrome presents clinically as an extensive mucocutaneous rash, accompanied by fever, lymphadenopathy, hepatitis, hematologic abnormalities with eosinophilia and atypical lymphocytes, and may involve other organs with eosinophilic infiltration, causing damage to several systems, especially to the kidneys, heart, lungs, and pancreas. Recognition of this syndrome is of paramount importance, since the mortality rate is about 10% to 20%, and a specific therapy may be necessary. The pathogenesis is related to specific drugs, especially the aromatic anticonvulsants, altered immune response, sequential reactivation of herpes virus and association with HLA alleles. Early recognition of the syndrome and withdrawal of the offending drug are the most important and essential steps in the treatment of affected patients. Corticosteroids are the basis of the treatment of the syndrome, which may be associated with intravenous immunoglobulin and, in selected cases, Ganciclovir. The article reviews the current concepts involving this important manifestation of adverse drug reaction.A síndrome Reação a Drogas com Eosinofilia e Sintomas Sistêmicos, também conhecida como Síndrome da Hipersensibilidade Induzida por Droga apresenta-se clinicamente como uma erupção cutâneomucosa extensa tipo exantemática, associada a febre, linfadenopatia, hepatite, anormalidades hematológicas com eosinofilia e linfócitos atípicos, e pode envolver outros órgãos, produzindo insuficiência renal, infiltrado eosinofílico cardíaco e pulmonar, além de pancreatite. O reconhecimento desta síndrome é de suma importância, uma vez que, a taxa de mortalidade é de cerca de 10% a 20% e uma terapia específica pode ser necessária. Sua etiopatogenia está relacionada a drogas específicas, principalmente os anticonvulsivantes aromáticos, alterações imunes, reativação sequencial de herpesvirus e associação com alelos do HLA. O pronto reconhecimento da síndrome e a retirada da droga desencadeante são os passos mais importantes e essenciais no tratamento dos doentes acometidos. Os corticosteróides são as medicações de escolha para o tratamento da síndrome, podendo ser associados imunoglobulina intravenosa e em, alguns casos selecionados, Ganciclovir. O artigo traz uma revisão dos conceitos atuais que envolvem essa importante manifestação de reação adversa a drogas.

La gastroenteritis eosinofílica es una enfermedad rara que se caracteriza por la presencia de eosinofilia hística que afecta diferentes capas de la pared intestinal por lo que desde el punto de vista histológico se clasifica en mucosa, muscular o serosa, según la capa de la pared intestinal en la que predomine el infiltrado. Puede localizarse en cualquier porción del tubo digestivo, pero excepcionalmente en el colon. Se presentó un caso de colitis eosinofílica en un paciente de 26 años de edad con síndrome diarreico crónico. Se exponen datos clínicos y estudios patológicos. Se revisó el tema.The eosinophilic gastroenteritis is a rare disease characterized by presence of histic eosinophilia involving different layers of the intestinal wall classified from the histological point of view in mucosa, muscular or serous, according to the layer of the intestinal wall with predominance of infiltrate. It may be located in any portion of the digestive tract, but exceptionally in the colon. This the case of eosinophilic colitis in a patient aged 26 with chronic diarrheic syndrome. Clinical data and pathologic studies results are showed. This matter was reviewed.

La gastroenteritis eosinofílica es una enfermedad rara que se caracteriza por la presencia de eosinofilia hística que afecta diferentes capas de la pared intestinal por lo que desde el punto de vista histológico se clasifica en mucosa, muscular o serosa, según la capa de la pared intestinal en la que predomine el infiltrado. Puede localizarse en cualquier porción del tubo digestivo, pero excepcionalmente en el colon. Se presentó un caso de colitis eosinofílica en un paciente de 26 años de edad con síndrome diarreico crónico. Se exponen datos clínicos y estudios patológicos. Se revisó el tema.

A piodermatite-pioestomatite vegetante é uma rara dermatose inflamatória de etiologia desconhecida, com típico comprometimento mucocutâneo. Relatamos caso de paciente feminina com lesões pustulosas e vesiculosas em axilas, evoluindo com placas vegetantes e pústulas com agrupamento anular. Houve progressão com comprometimento vulvar, inguinal e mucosas oral, nasal e ocular. Proposto o diagnóstico, optou-se por iniciar prednisona 40mg ao dia, com remissão das lesões após um mês de uso da medicação. A associação com doença inflamatória intestinal ocorre em 70% dos casos. A imunofluorescência é um fator que ajuda a caracterizar a doença, sendo tipicamente negativa. A rápida resposta à terapêutica com corticosteroides sistêmicos é esperadaPyodermatitis-pyostomatitis vegetans is a rare inflammatory dermatosis of unknown etiology, with a typical mucocutaneous involvement. We report the case of a woman with pustular and vesicular lesions in the axillae, evolving with vegetating plaques and pustules with annular grouping. The disease progressed with vulvar and inguinal involvement as well as involvement of the oral, nasal and ocular mucous membranes. She started the treatment with prednisone (40 mg/day), with remission of the lesions after one month of use of such medication. Association with inflammatory bowel disease occurs in 70% of the cases. Immunofluorescence, which is typically negative, helps to characterize the disease. A rapid response to systemic steroids is expected

Fundamento: La fasciolosis continua siendo una zoonosis de aparición frecuente. La frecuencia de la infección humana se ha subestimado en los últimos años, no obstante, aun se reportan casos y pequeños brotes de evolución variable, asociados a la ingestión de verduras o agua contaminadas. Caso Clínico: se presentaron dos casos con eosinofilia marcada, con manifestaciones clínicas y antecedente epidemiológico de consumir berro de origen silvestre. Se demuestra la importancia del antecedente epidemiológico en la confirmación de los casos. Conclusiones: la clínica referida, eosinofilia marcada y el antecedente epidemiológico de consumo de berro u otras verduras que puedan estar contaminadas, resultan elementos de vital relevancia para establecer un diagnóstico oportuno de esta enfermedad.Base: Fascioliasis is a zoonosis that maintains its frequent onset. The rate of recurrence of the human infection has been underestimated in the last years; however case reports remain and only some onsets of variable evolution associated with the consumption of vegetables or contaminated waters are reported. Clinical Case: two cases presenting a marked eosinophilia and the epidemiological history of watercress consumption and/or other potentially contaminated vegetables are crucial elements to be considered to establish the appropriate diagnosis of this disease.

Meningitis caused by Angiostrongylus cantonensis has recently been reported in patients resulting from the first outbreaks in subtropical regions of Ecuador. METHOD: Eight young adult patients from the two outbreaks were studied. IgA, IgM, IgG and albumin in cerebrospinal fluid and serum were quantified and plotted in cerebrospinal fluid/serum quotient diagrams (Reibergrams). The anamnesis on the patients included asking about any consumption of raw snails, symptoms and harm caused. RESULTS: Mean eosinophilia of 7.5% and 26% in serum and cerebrospinal fluid respectively was observed, as well as a moderate increase in total proteins. The most frequent pattern of intrathecal synthesis was observed in three classes of immunoglobulins. Intrathecal synthesis of IgM was observed in all cases two weeks after the first symptoms appeared. CONCLUSION: The intrathecal synthesis patterns of eosinophilic meningitis due to Angiostrongylus cantonensis, facilitated by cerebrospinal fluid analysis, were similar to those of previous cases from abroad.

Se presenta un caso de un hombre de 81 años natural de zona rural, agricultor, recolector de café 50 años atrás y jardinero por 22 años en Bogotá. Consultó por dolor abdominal de 10 días de evolución, localizado hacia mesogastrio y epigastrio. Además, disnea, tos productiva. Antecedentes: enfermedad pulmonar obstructiva crónica, cor pulmonale, fumador de 25 paquetes /año, había recibido prednisona oral y beclometasona inhalada en diversas ocasiones incluso en la última hospitalización. En el examen físico presentó signos de desnutrición, taquicardia, taquipnea; estertores en base del hemitórax derecho; abdomen: blando, depresible con dolor a la palpación profunda en epigastrio e hipocondrio derecho. Ingresó con síndrome de respuesta inflamatoria sistémica por taquicardia, taquipnea, leucocitosis 37.600 y eosinofilia 52-60%, Ig E: 180 UI/ ml. Se evidenciaron larvas rabditiformes de Strongyloides stercoralis en esputo y materia fecal. La radiografía de tórax mostró derrame pleural derecho, la ecografía hepática fue normal, la endoscopia de vías digestivas altas evidenció gastritis y duodenitis. Se inició tratamiento con ivermectina 200 mg/Kg/dosis, con seguimiento clínico y de laboratorio con evolución clínica satisfactoria.

Se presenta el caso de un varón de cuatro años y medio con toxocariosis atípica, procedente de La Matanza, Morropón, Piura. El paciente presentó síntomas inespecíficos durante nueve días; la sospecha de toxocariosis derivó del hallazgo de eosinofilia periférica marcada (15% ó 1470 células/μL) en el hemograma. El diagnóstico se confirmó por serología mediante el método de enzimoinmunoanálisis (ELISA) demostrando la presencia de anticuerpos anti-Toxocara de tipo IgG, así como de tipo IgM. El cuadro se autolimitó antes de que el paciente recibiera tratamiento con albendazol 15mg/ kg/día durante cinco días.We present the case of a 4.5 years old boy with atypic toxocariasis, from La Matanza, Morropon, Piura. The patient had non-specific symptoms during 9 days. Suspicion of Toxocariasis was supported by marked eosinophilia in the cell blood count (15% or 1470 cells/μL). Diagnosis was confirmed by laboratory with ELISA serology demonstrating the presence of IgG and IgM anti-Toxocara antibodies. Symptoms receded before the patient received a five-day treatment with albendazol 15mg/kg/day.

A eosinofilia no sangue e em tecidos está habitualmente associada a condições alérgicas, infecciosas, inflamatórias, neoplásicas, endocrinológicas, uso de medicamentos e exposição a agentes tóxicos. No entanto, pode ocorrer proliferação eosinofílica primária, sem causa aparente ou por expansão clonal da célula-tronco hematopoética. As neoplasias mielo ou linfoproliferativas associadas a rearranjos gênicos como PDGFRα, PDGFRβ e FGFR1 constituem condições raras nas quais ocorre mieloproliferação crônica, alterações no sangue periférico e na medula óssea e lesão tecidual de diferentes órgãos, a partir da liberação de citocinas e fatores humorais pelos grânulos eosinofílicos. A presença do rearranjo PDGFRα relaciona-se comumente à leucemia eosinofílica crônica, com envolvimento de mastócitos e neutrófilos e, mais raramente, à leucemia mielóide aguda ou ao linfoma linfoblástico T, com eosinofilia. O rearranjo PDGFRα mais comum é aquele resultante da deleção intersticial no braço longo do cromossomo 4, que permite a formação de um neogene a partir da fusão dos genes FIP1L1 e PDGFRα. Este codifica uma tirosino-quinase constitutivamente ativa que é inibida pelo mesilato de imatinibe. Em 2002 foi relatado o uso bem sucedido de mesilato de imatinibe em baixas doses em um paciente com síndrome hipereosinofilica e, desde então, vem-se utilizando esta droga com respostas clínicas rápidas, completas e duradouras. Descrevemos um caso de LEC com expressão do rearranjo FIP1L1-PDGFRα.Chronic eosinophilia is habitually associated with allergic, infectious, inflammatory, neoplastic and endocrine conditions and exposure to certain drugs and toxic agents. However, eosinophilic proliferation may be primary, without identifiable causes, or provoked by clonal hematopoietic stem cell proliferation. Gene fusions involving PDGFR-α, PDGFR-β, and FGFR1 predispose patients to rare conditions with chronic myeloproliferation or lymphoproliferation, alterations in peripheral blood and bone marrow and diffuse tissue injury due to the release of cytokines and humoral factors from eosinophilic granules. The presence of the PDGFR-α rearrangement is commonly related to chronic eosinophilic leukemia, with alterations in peripheral mastocytes and neutrophils, and rarely to acute myeloid leukemia or T lymphoblastic lymphoma with eosinophilia. The most prevalent PDGFR-α rearrangement is one resulting from an interstitial deletion in the long arm of chromosome 4, that allows the formation of a neogene from the fusion of the FIP1L1 and PDGFRα genes. This codes a constitutively active tyrosine kinase, which can be inhibited by imatinib mesylate. In 2002, the successful treatment of a patient using imatinib to treat hypereosinophilic syndrome was reported. Since then, this drug has been utilized with fast, complete and lasting clinical responses. Here we describe a case of chronic eosinophilic syndrome with expression of the FIP1L1-PDGFR-α rearrangement.

Se realizó una revisión bibliográfica para actualizar y sistematizar la información existente sobre la infección humana por el género Toxocara. Se describe los mecanismos de transmisión, epidemiología, formas clínicas, métodos de diagnóstico, esquemas de tratamiento. Además, se resalta su importancia como causa infecciosa de ceguera, en población joven, que resulta potencialmente prevenible y curable mediante el diagnóstico precoz. Por lo cual, se plantea propuestas para implementar la vigilancia epidemiológica. Asimismo, algunas sugerencias para mejorar la legislación existente que permita disminuir el riesgo de la transmisión a la población en general e incrementar el conocimiento que existe sobre esta infección en nuestro país.

A infecção primária por Paracoccidioides brasiliensis é observada raramente. Um paciente masculino de 28 anos de idade apresentou febre, sintomas respiratórios e indisposição durante três meses. Exames radiológicos evidenciaram infiltrado pulmonar apical bilateral, pleurite à direita e linfadenomegalia hilar. O paciente apresentava leucocitose, intensa eosinofilia e títulos crescentes de anticorpos séricos anti-P. brasiliensis. Até onde sabemos, este é o primeiro relato do complexo primário da paracoccidioidomicose, associado com hipereosinofilia, apresentado por um adulto previamente hígido.Primary infection with Paracoccidioides brasiliensis has rarely been observed. A 28-year-old male patient presented with a three-month history of fever, respiratory symptoms and malaise. Chest X-rays revealed bilateral apical infiltrates, right pleuritis and hilar lymphadenomegaly. The patient presented with leukocytosis, severe eosinophilia and increasing titers of anti-P. brasiliensis antibodies in serum. To our knowledge, this is the first report of the primary pulmonary lymph node complex of paracoccidioidomycosis accompanied by hypereosinophilia and affecting a previously healthy adult.

A hiperplasia angiolinfoide (Hale e doença de Kimura são duas entidades que podem se manifestar como nódulos, placas ou pápulas, de localização predominante em face, região retroauricular e cervical. São causas raras de eosinofilia e ainda há muita discussão em torno de suas etiopatogenias. Para alguns autores trata-se de duas patologias distintas enquanto para outros são manifestações diferentes da mesma doença. O presente artigo relata o caso de um paciente asiático que apresentava história de prurido generalizado há um ano, acompanhado de pápulas em membros e nódulo de aproximadamente 5 cm de diâmetro em região retroauricular direita com aumento progressivo. O hemograma apresentava leucocitose às custas de eosinofilia. Os achados sugerem uma superposição entre as duas patologias, pois clinicamente são sugestivos de doença de Kimura, mas a histopatologia e imuno-histoquímica confirmaram a origem endotelial da lesão, sendo compatível com Hale. Os autores destacam a raridade do caso como causa de eosinofilia, assim como alertam para a dificuldade do diagnóstico e da diferenciação entre as duas patologias.Angiolymphoid hyperplasia (Hale) and Kimura disease are two entities that can manifest as subcutaneous nodules, plaques, or papules, and the predominant localization is face, retroauricular and cervical region. They are rare causes of eosinophilia and there is discussion regarding their etiopathogenesis. Some authors propose that these two diseases are truly individual, but others say that they are separate points on a single spectrum. This article is a case report of an asian patient that showed a one year duration of generalized pruritus, with papules on the limbs and a 5 centimeter nodule on the right retroauricular region with slow progression of the size. The hemogram showed leucocitosis with eosinophilia. These findings suggest an overlap between these two diseases, they are clinically suggestive of Kimura disease diagnosis, but the histopathology with HE and immunohistochemistry confirmed the endothelial origin of the lesion that was compatible with Hale. The authors emphasize the rarity of the case as the cause of eosinophilia, also alert for the challenge of the diagnosis and distinction between these two diseases.

RACIONAL: A esofagite eosinofílica é uma entidade recentemente descrita, caracterizada por sintomas esofágicos, semelhantes aos da doença por refluxo gastroesofágico e importante eosinofilia esofágica. OBJETIVO: Apresentação de 29 pacientes com esofagite eosinofílica, discutindo as características clínicas, diagnóstico, tratamento e evolução. MÉTODOS: Foram identificados 29 pacientes (22 do sexo masculino) com idade entre 1 e 18 anos, nos quais as biopsias de esôfago demonstraram contagem de 20 ou mais eosinófilos/campo de grande aumento, sem infiltração eosinofílica em antro e/ou duodeno. Avaliaram-se as manifestações clínicas, achados endoscópicos e histológicos, tratamento e evolução. RESULTADOS: Os sintomas mais freqüentes foram vômitos em 15 pacientes (52%) e dor abdominal em 11 (38%). Os pacientes com idade inferior a 4 anos apresentavam recusa alimentar e baixo peso. Os com idades entre 5 e 8 anos apresentavam predominantemente dor abdominal e/ou pirose e/ou vômitos. Os pacientes com mais de 8 anos apresentavam dor abdominal, disfagia e/ou impactação alimentar eventual. Os achados endoscópicos incluíram estrias verticais em 14 pacientes (48%), pontilhado branco em 12 (41%), anéis circulares em 2 (7%) e esofagite erosiva em 3 (10%). Em sete pacientes a endoscopia foi normal (24%). O tratamento incluiu fluticasona tópica em 19 pacientes e restrição dietética em 7. Os pacientes acompanhados apresentaram resposta favorável ao tratamento, com melhora ou remissão dos sintomas. Onze pacientes que foram submetidos a endoscopia de controle pós-tratamento apresentaram diminuição significativa do número de eosinófilos no esôfago. CONCLUSÕES: A esofagite eosinofílica deve ser considerada quando há sintomas de refluxo, que não respondem ao tratamento habitual. Os exames endoscópicos devem ser acompanhados de biopsias com análise detalhada do número de eosinófilos.BACKGROUND: Eosinophilic esophagitis is a recently described entity with esophageal symptoms like gastroesophageal reflux disease and significant esophageal eosinophilic infiltration. AIM: To present our clinical series of 29 children with eosinophilic esophagitis, describing the clinical and diagnostic features, treatment and outcome. METHODS: We describe 29 patients (22 boys), 1-18 years-old, with 20 eosinophils per high-power field in esophageal biopsy specimens and absence of eosinophilic inflammation in the stomach and duodenum. Evaluation of the clinical, endoscopic and histologic findings, treatment and outcome was undertaken. RESULTS: The most common presenting symptoms included vomiting in 15 patients (52%) and abdominal pain in 11 patients (38%). Children under the age of 4 years presented with feeding disorder and failure to thrive. Patients between 5 and 8 years of age presented commonly with abdominal pain or symptoms that may be associated with reflux (heartburn and/or vomiting). Patients over the age of 8 presented most often with abdominal pain, dysphagia and occasional food impaction. Endoscopic features included vertical furrowing in 14 patients (48%), whitish papules in 12 (41%), corrugated rings in 2 patients (7%) and esophageal erosions in 3 patients (10%). In seven patients endoscopy was normal (24%). Treatment included swallowed fluticasone propionate in 19 patients and restriction diet in 7 patients. Patients who returned for follow-up had either improvement or remission of symptoms. After treatment, endoscopic biopsies were repeated in 11 patients, and a significant decrease in esophageal eosinophil counts was observed. CONCLUSIONS: The diagnosis of eosinophilic esophagitis must be considered when symptoms of reflux do not respond to conventional treatment. Upper gastrointestinal endoscopy must be complemented by a detailed analysis of histologic findings and eosinophil counts.

Eosinophilic granulomatosis with polyangiitis (EGPA) is a systemic vasculitis characterized by the presence of asthma associated with eosinophilia, eosinophilic infiltration of different organs, and vasculitis of small and medium-sized vessels. Although classified as anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis, it occurs in less than half of the patients. The disease is infrequent, typically appearing in patients with asthma and affecting multiple organs such as lung, skin and peripheral nervous system. Treatment has been based on the use of glucocorticoids and immunosuppressants. In recent years, progress has been made in the knowledge of the pathophysiology, in treatment with the inclusion of biologic agents, the classification criteria have been revised and new therapeutic recommendations have been published., (Copyright © 2023 Elsevier España, S.L.U. All rights reserved.)

A síndrome de Wells é dermatose inflamatória benigna rara, de curso recorrente, descrita em todas as idades e sem predileção por sexo, de etiologia e patogênese desconhecidas. Embora sua autonomia seja questionada, a síndrome de Wells é entidade distinta cujo diagnóstico se faz pela combinação de quadro clínico marcante, achados histopatológicos típicos quando associados à clínica, e curso característico.Wells’ syndrome is a rare, benign, recurrent, inflammatory dermatosis affecting all age groups, with no sex predilection. Its etiology and pathogenesis remain unknown. Although its autonomous existence is questioned by some, Wells’ syndrome is a distinct disease entity diagnosed by the combination of a striking clinical picture, typical histological finding when associated to the clinical features, and a characteristic time course.

Se presenta dos casos de neumonía eosinofílica idiopática, uno crónico y otro agudo. En el caso clínico 1 se realizó una confirmación anatomopatológica de neumonía eosinofílica idiopática y en el caso clínico 2 se tuvo una neumonia eosinofílica aguda probable. Ambos presentaron tos, fiebre y disnea. El estudio radiográfico reveló lesiones alveolares bilaterales con tendencia a la consolidación. La marcada eosinofilia en sangre periférica fue un dato resaltante que facilitó el diagnóstico. Ambos casos tuvieron muy buena respuesta a la corticoterapia.(Rev Med Hered 2007;18:39-44).

Relata-se o caso de uma mulher de 25 anos com síndrome de Churg-Strauss, cujos sintomas surgiram aos dezesseis anos, logo após o início do uso de contraceptivo oral. O quadro clínico evoluiu rapidamente com asma persistente grave, polipose nasal, rinite perene obstrutiva, eosinofilia periférica e tecidual, e mononeurite. A síndrome de Churg-Strauss é uma doença que exige suspeita precoce, diagnóstico preciso, tratamento agressivo e monitoramento periódico, devendo ser considerada no diagnóstico diferencial de asma persistente moderada e grave. O caso relatado chama a atenção para possível participação hormonal e surgimento em idade precoce.We report the case of a 25-year-old woman with Churg-Strauss syndrome, the symptoms of which had first appeared soon after she began taking oral contraceptive at the age of sixteen. The clinical profile evolved rapidly to severe persistent asthma, nasal polyposis, perennial obstructive rhinitis, eosinophilia (peripheral/tissue) and mononeuritis. Churg-Strauss syndrome is the type of disease that demands early detection, accurate diagnosis, aggressive treatment and periodic monitoring. It should be considered in the differential diagnosis of moderate and severe persistent asthma. The case reported calls attention to possibility that there is a hormonal component and that the disease can present early onset.

Abstract: A parasitological, nutritional and hematological evaluation was carried out on 103 children of both sexes between 4-12 years of age from a rural school at Santa Fe, Sucre state, Venezuela, from January-March 2003. Fecal samples were analyzed using a fresh test, Willis Malloy, and the quantitative Kato-Katz method. Nutritional status was determined by anthropometric indexes combinations. Haematological parameters were evaluated by classical methods and the degree of eosinophilia was expressed in absolute eosinophil counts. Exactly 93.2% of schoolchildren were found to have parasites with high poliparasitism (83.3%). Intestinal helminths prevalence was 82.5%, highlighted by 69.4% of Trichuris trichiura and Ascaris lumbricoides association, with a predominant light intensity of infestation. Around 91.2% (31/34) of individuals with malnutrition presented helminthiasis. Eosinophilia was found in 97.6% of schoolchildren infested by helminths (p< 0,001). And 83.3% (20/24) were infested by helminths in the group of children with anemia (23.3%). About 88.8% of children with intestinal helminthiasis belonged to the VTH level socioeconomic stratum. These findings suggest that the school population evaluated lives in a high helminth hyperendemic area, consistent with the socioeconomic stratum found. Additionally, it was established that eosinophilia in these schoolchildren is a factor associated with intestinal helminthiasis. Resumen: Se realizó una evaluación parasitológica, nutricional y hematológica en 103 niños de ambos sexos, entre 4-12 años de una escuela rural en Santa Fe, estado Sucre, Venezuela, durante el período enero-marzo 2003. Las muestras de heces se analizaron mediante un examen al fresco, Willis-Malloy y Kato-Katz cuantitativo. El estado nutricional se determinó utilizando la combinación de los índices antropométricos. Los parámetros hematológicos fueron evaluados por los métodos clásicos, y el grado de eosinofilia se expresó en valores absolutos de eosinófilos. 93,2% de los escolares estaban parasitados, presentando elevado poliparasitismo (83,3%). La prevalencia de helmintos intestinales fue de 82,5%, destacando la asociación de Trichuris trichiura y Ascaris lumbricoides (69,4%) y predominando una intensidad de infestación leve. De los individuos con desnutrición, el 91,2% (31/34) tenían helmintiasis. En 97,6% de los escolares infestados por helmintos se encontró eosinofilia (p

DRESS syndrome is a skin rash, fever, eosinophilia Multivisceral commitment, incidence of 1 in 20,000 / 50.0000 in individuals exposed to the drugs involved. School 8 years epilepticus three weeks of starting phenytoin presented four days of high fever, unquantified, with maculopapular rash pruritic scaly erythematosus and bilateral inguinal lymphadenopathy. Paraclinical leukocytosis with eosinophilia, elevated transaminases, abnormal clotting times and severe hepatic failure with adequate response to treatment without the use of systemic steroids. The anti-convulsant drugs may be hypersensitive with major dermatological symptoms, failure kidney-liver and increases theriskofdevelopingsystemicreactionsmoresevereaserythroderma, toxicepidermalnecrolysisand/ orStevens-Johnsonsyndromeandevendeathifuntreatedproperly., even more so in the pediatric stage, since there is no clinical evidence that allows us to determine whether a drug used can trigger a hypersensitivity reaction as described. [ABSTRACT FROM AUTHOR]

Scirrhous eosinophilic gastritis (SEG) is characterized by diffuse infiltration of eosinophils and concomitant fibrovascular tissue proliferation in the stomach wall. The condition is a rare occurrence with an unknown cause. Two dogs were examined with a history of progressive weight loss, emesis, melena and anorexia. Complete blood cell counts of both cases revealed anemia and eosinophilia, while ultrasonography examination revealed thickening of the stomach wall. Due to suspected gastric neoplasia and a poor clinical prognosis, the dogs were euthanized. At necropsy, both had markedly distended stomachs with a diffusely thickened and firm wall. The spleens of both dogs were enlarged with a nodular surface. Histological evaluation revealed diffuse infiltrate of eosinophils, fibrovascular tissue proliferation and fibrinoid degeneration in blood vessel walls of stomach and spleen. SEG is a rare pathological condition that must be considered as a possible diagnosis in dogs presenting gastrointestinal signs and eosinophilia. [ABSTRACT FROM AUTHOR]

Drug reaction with eosinophilia and systemic symptoms (DRESS) is a potentially fatal cutaneous reaction to drugs, which has an unclear pathogenesis. It is commonly associated with fever, lymphadenopathy, visceral involvement, and hematologic disorders including eosinophilia. Herein, we present the case of a 22-year-old man who had been receiving antibiotics and analgesics for a respiratory infection, and developed an exanthem that spread throughout most of the body, fever, altered liver, and kidney tests. The skin biopsy was consistent with a drug reaction. The patient notably improved after discontinuation of the offending drugs and corticosteroid treatment. Prompt diagnosis through clinical and laboratory criteria is crucial given the multisystemic and potentially fatal nature of this disease. [ABSTRACT FROM AUTHOR]

Recurrent eosiniphilic cutaneous necrotizing vasculitis is a recently identified rare entity. It is characterized by a necrotizing vasculitis of small vessels of the dermis with an infiltration almost exclusively of eosinophils, with minimal or no leukocytoclasia. Clinically, it is characterized for recurrent erythematous or purpuric papules, some of them with annular configuration, and angioedema. In most of the cases there is peripheral eosinophilia, but without systemic involvement. [ABSTRACT FROM AUTHOR]

Relata-se um caso de síndrome hipereosinofílica idiopática associada à doença eosinofílica disseminada em um cão, macho, mestiço Pastor Alemão, com cinco anos de idade. Os sinais clínicos incluíam apatia, anorexia, intolerância ao exercício, caquexia, dispnéia e taquicardia. Laboratorialmente, havia reação leucemóide eosinofílica e na citologia da medula óssea observou-se acentuada hiperplasia eosinofílica. Radiologicamente, detectou-se uma área radiopaca intratorácica bilateral cranial ao coração. A punção aspirativa intratorácica demonstrou grande quantidade de eosinófilos, o que permitiu um diagnóstico clínico de infiltração pulmonar com eosinofilia. O diagnóstico foi confirmado histologicamente.

Pyodermatitis-pyostomatitis vegetans is a rare mucocutaneous dermatosis characterized by pustular and vegetating lesions of the skin and oral mucosa. It is considered a highly specific marker for inflammatory bowel diseases. The authors describe a case of pyodermatitis-pyostomatitis vegetans in a pediatric patient who presented marked clinical improvement after beginning treatment with oral corticosteroids, azathioprine, and dapsone. Bowel surveillance is mandatory, since the dermatosis is associated with inflammatory bowel diseases in more than 70% of patients, especially ulcerative colitis.A piodermatite-pioestomatite vegetante é uma dermatose mucocutânea rara, caracterizada por lesões pustulosas e vegetantes na pele e mucosa oral. É considerada um marcador altamente específico para doenças intestinais inflamatórias. Os autores descrevem um caso de piodermatite-pioestomatite vegetante em paciente pediátrico, o qual apresentou boa resposta a corticoterapia oral associada à azatioprina e à dapsona. A vigilância intestinal é mandatória, uma vez que a dermatose está associada a doenças intestinais inflamatórias em mais de 70% dos casos, especialmente a colite ulcerativa.

Os autores apresentam dois casos de hiperplasia angiolinfóide com eosinofilia, doença relativamente rara. Uma das pacientes apresentava lesões exuberantes e de localização incomum, já que é em geral situada na cabeça e/ou no pescoço. A histopatologia corada com HE e a imuno-histoquímica com fator VIII confirmaram o diagnóstico e a origem endotelial das lesões de ambas as pacientes.The authors present two cases of the relatively uncommon disease angiolymphoid hyperplasia with eosinophilia, which is usually located on the head and/or neck. One of the patients showed exuberant lesions and unusual site. Histopathology with HE and immunohistochemistry with factor VIII confirmed the diagnosis and the endothelial origin in both cases.

La Ictiohematología es una herramienta de uso común con fines clínicos en peces de importancia económica, con un menor aporte en la comprensión de la fisiología del organismo en relación con su medio. En este contexto y frente a la escasa información publicada de aspectos hematológicos de condrictios, se propuso caracterizar los leucocitos de la pintarroja Schroederichthys chilensis y determinar los valores de referencia cuantitativos. Se obtuvo sangre de pintarrojas capturadas en la bahía Coliumo (VIII Región, Chile). En extensiones teñidas con May-Grünwald Giemsa se caracterizó los siguientes leucocitos: linfocitos, granulocitos eosinófilos, granulocitos polimorfonucleares heterófilos, monocitos, blastos y trombocitos. Los leucocitos, en general, presentaron características similares a las descritas en otros peces, destacando la elevada presencia de eosinófilos con gránulos prominentes. Cuantitativamente, se encontraron en el siguiente orden: trombocitos (40-50%) eosinófilos (15-25%) linfocitos (18-25%) heterófilos (5-9%) monocitos (0-1%) = blastos (0 _ 1%). En comparación con otros peces, la eosinofilia (la más elevada descrita en peces) produce una distorsión de la fórmula leucocitaria, posiblemente por la presencia de trypanosoma humboldti en la sangre. Los parámetros hematológicos informados son un aporte al conocimiento de la especie y servirán como base comparativa para futuras aplicacionesIchthyohematology is a common tool in the clinic analysis of economically important fish, and used less to understand fish physiology in relation to the environment. In this context and because of the scarce information about the condrictian hematology, we characterize the leukocytes of the Chilean catshark Schroederichthys chilensis and determine the quantitative reference values. Blood was obtained from fish caught in Coliumo Bay (VIII Región, Chile). Slides were stained with May Grünwald Giemsa. Lymphocytes, eosinophil granulocytes, heterophils granulocytes, monocytes, blasts and thrombocytes were characterized. The leukocytes show similar characteristics to other fish, emphasizing the high number of eosinophils with big granules. Quantitatively the rank order is: thrombocytes (40-50%) eosinophils (15-25%) lymphocytes (18-25) heterophils (5-9%) monocytes (0-1%) = blasts (0 - 1%). Comparing with other fish, the catshark eosinophilia (the highest reported among fishes) produces a distortion in the differential leukocyte count, probably due to the presence of Trypanosomes in the blood. The hematological parameters here reported are important for the species knowledge and will be useful as a comparative base for future studies

Se sabe que la gastroenteritis eosinofílica (GE) es un desorden raro donde existe una infiltración parcheada y variable de la pared del tracto gastrointestinal por eosinófilos maduros y los síntomas se correlacionan con el patrón de infiltración y el sitio afectado. Se hallan, con frecuencia, pacientes con formas mixtas de la enfermedad, el patrón menos común es la forma predominantemente subserosa, encontrada en menos del 10 % de los casos, con un líquido ascítico rico en eosinófilos. Aunque su patogénesis no está del todo clara, varias características sugieren alergia alimentaria. Se presentó una paciente de 59 años con cuadro de ascitis eosinofílica, dolor abdominal, vómitos y diarreas; tuvo pruebas cutáneas de alergia a alimentos positiva y títulos elevados de IgE. Se excluyeron otras causas de ascitis eosinofílicas y se llegó a la conclusión que se trataba de GE (Klein tipo III). Se explicó la relación entre eosinófilos y distintas citoquinas, así como la función de mediadores de la inflamación producidos por ellos en este modelo de enfermedadIt is known that eosinophilic gastroenteritis is a rare disorder in which there is a patched variable infiltration of the gastrointestinal tract wall by mature eosinophils, and symptoms are correlated with the pattern of infiltration and the affected site. Frequently, there are patients with mixed forms of the disease, the less common pattern is the predominantly subserose form found in less than 10 % of cases, with eosinophil-rich ascitic liquid. Although the pathogenesis is not clear, several characteristics suggest food allergy. A 59-years-old patient presented with a picture of eosinophilic ascitis, abdominal pain, vomit and diarrheas, she also had positive food allergy skin tests and high IgE titers. Other causes of eosinophilic ascitis were excluded and it was concluded that the disease was eosinophilic gastroenteritis (Klein type III). The relationship between eosinophils and various cytokines as well as the function of inflammation mediators produced by both of them in this type of disease was explained

Drug reaction with eosinophilia and systemic symptoms syndrome (DRESS Syndrome) is caused by many different aetiological factors. We present the case of a 56-year-old woman who started allopurinol treatment about 3 weeks before. She presented with fever, hypotension, tachycardia, generalized maculopapular cutaneous rash, facial edema and axillar, inguinal and cervical enlarged lymph nodes. Complementary diagnostic exams: slight lymphocytosis, eosinophilia, acute renal failure, elevated hepatic enzymes. Swab for SARS-CoV-2 was positive. Serologic tests for another virus were negative. Histopathological analysis was compatible with DRESS syndrome. SARS-CoV-2 could also be taken into account when suspected DRESS syndrome.

Introduction: The drug sensitivity syndrome with eosinophilia and systemic symptoms (DRESS) is a hypersensitivity reaction that is triggered by multiple drugs, such as antibiotics, anti-inflammatories, anticonvulsants, among others, occurring in 2.2% of hospitalized patients. Its importance lies in its high mortality can reach 30%. Case report: 47-year-old man with a history of epilepsy untreated, that the short time of starting anticonvulsant therapy with phenytoin, evolved with fever, maculopapular pruritic erythematous skin lesions on the trunk and extremities. In urgency room, he presented hemodynamically unstable, with fever, and congestive pharynx. Laboratory tests revealed eosinophilia, elevated liver tests and C-reactive protein. He was hospitalized with a diagnosis of scarlet fever and was treated with sodium penicillin. It evolved unfavorably adding myalgia and polyarthralgia. On suspicion of bacteremia, antibiotic clindamycin was changed, but then was discontinued for negative cultures. It was proposed DRESS induced by phenytoin, remitting the symptoms when discontinue phenytoin, with normalization of liver function and eosinophils. Patient develops afebrile and in good general condition. Discussion: It is a serious disease of difficult diagnosis and high mortality which should always rule out viral, immunological or tumor etiology. As an initial management should discontinue the drug involved early with constant vigilance. The use of corticosteroids as adjunctive therapy is controversial. [ABSTRACT FROM AUTHOR]

Tuberculosis has increased all over the world. This paper reports the case of a male patient with tuberculous meningitis, spinal tuberculosis (Pott's disease) and severe adverse reactions to antituberculosis drugs. He had skin rash, hepatitis, eosinophilia and fever; all these signs make the diagnosis of DRESS syndrome. This syndrome is caused by a severe hypersensitivity reaction to different drugs. It is usually caused by anti-convulsants, sulfonamides and some antiviral drugs, among other drugs. Anti-tuberculosis drugs can also cause this potentially fatal syndrome. The importance of surveillance for early detection and treatment of adverse drug reactions is emphasized. [ABSTRACT FROM AUTHOR]

The Toxocara canis (Tc) is a parasite that belongs to the nematode phylum and has dogs as definitive host. The men can be accidentally contaminated by ingesting eggs containing infective larvae of the parasite. These larvae, when ingested, pass through the intestinal mucosa, reach the portal circulation and migrate through different tissues of the host. During this process, excretory-secretory antigens (TES) are released causing an intense inflammatory reaction, the Th2 type, characterizing the syndrome, called Visceral Larva migrans (VLMS). The main features of this chronic disease are blood and tissue eosinophilias. Thus, it is important to search for therapies that may contribute to the reduction of inflammatory conditions with intense eosinophilia. In this study, we investigated the use of a biotherapic produced from the antigenic extract from eggs and larvae (Tc) and its effect on the recruitment of total leukocyte, mononuclear cells and eosinophils in blood, bronchoalveolar space and peritoneal cavity of mice infected with (Tc). Female mice (Swiss) were used divided in three groups: control (C), Infected (Tc) Immunized (Im + Tc) and Treaty (Tc + Bio). The animals Tc, Im + Tc and Tc + Bio received 500 eggs / animal by gavage. Subsequently, the animals were euthanized on day 18 after infection and the number of cells in the compartments was determined. Our results showed that, Im + Tc, as in Tc + Bio had reduced these cells in compartments analyzed compared to Tc group. Thus, it was suggested that the biotherapy negatively modulated the recruitment of inflammatory cells, particularly eosinophils in blood, lung and intestine demonstrating an anti-inflammatory potential of the biotherapic in the experimental VLMS. [ABSTRACT FROM AUTHOR]

Background: Allergic rhinitis and bronchial asthma are airways chronic inflammatory processes, with a correlation of 28-78%. Objectives: To determine the prevalence and classification of allergic rhinitis on asthmatic patients, according to the workshop Allergic Rhinitis and its Impact on Asthma (ARIA), and to assess the total serum concentrations of IgE and the presence of nasal and blood eosinophilia. Material and method: A study was done with asthmatic patients ages 7 to 14, attending the Pediatric Service at the Hospital General del Sur Dr. Pedro Iturbe, Maracaibo, Estado Zulia, Venezuela. Subjects were polled for signs and symptoms suggesting allergic rhinitis and its impact on quality of life. Blood and nasal swab samples were taken to perform laboratory tests in study. Results: There were 60 asthmatic patients, 73.3% males and 70% scholar age patients. The prevalence of allergic rhinitis was 93.3%, according to ARIA classification. Mild intermittent group was the most frequent type, with 42.8% the most frequent clinic sign was the allergic shiners (86.6%), and the predominant symptom was the nasal aqueous trickle (83.3%), while sleep disorders were the most common affection of quality of life (39.2%). In 85.7% of patients eosinophil percentage was higher than 3%, whereas in 75% total serum IgE values were higher than 100 Ul/mL. In patients with rhinitis, 61.9% of the nasal mucus showed altered eosinophils percentage higher than 10%. Conclusion: A high prevalence of allergic rhinitis is present in asthmatic patients, confirmed by laboratory tests, which proves an inflammatory response mediated by IgE. [ABSTRACT FROM AUTHOR]

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