Asthma with eosinophilia

 Q: 48 years old female is admitted to ICU with severe exacerbation of asthma. Patient's blood workup showed significant eosinophilia with >1500 eosinophils/microL. What are few differential diagnoses?

Answer: Late presentation of exacerbation of asthma with significant eosinophilia should lead a clinician to think of other related diseases. Significant eosinophilia is defined as >15 percent or >1500 eosinophils/microL. Major catastrophic diseases should be ruled out besides allergic asthma such as 

• strongyloides 
• drug reactions 
• allergic bronchopulmonary aspergillosis 
• eosinophilic granulomatosis with polyangiitis (Churg Strauss), and 
•  hypereosinophilic syndrome

#pulmonary

References:

1. Bakakos A, Loukides S, Bakakos P. Severe Eosinophilic Asthma. J Clin Med. 2019;8(9):1375. Published 2019 Sep 2. doi:10.3390/jcm8091375 

2. Walford HH, Doherty TA. Diagnosis and management of eosinophilic asthma: a US perspective. J Asthma Allergy. 2014;7:53-65. Published 2014 Apr 11. doi:10.2147/JAA.S39119 

3. Bousquet J, Chanez P, Lacoste JY, Barnéon G, Ghavanian N, Enander I, Venge P, Ahlstedt S, Simony-Lafontaine J, Godard P, et al. Eosinophilic inflammation in asthma. N Engl J Med. 1990 Oct 11;323(15):1033-9. doi: 10.1056/NEJM199010113231505. PMID: 2215562.

4. Allen JN, Davis WB. Eosinophilic lung diseases. Am J Respir Crit Care Med 1994; 150:1423.