A 66-Year-Old Man With Subacute Cough and Worsening Dyspnea Previously Diagnosed With COVID-19 Pneumonia

A 66-year-old man presented with subacute cough and worsening dyspnea. Labs were notable for moderate peripheral eosinophilia, and computed tomography (CT) scan demonstrated extensive crazy-paving throughout bilateral upper lung fields. Bronchoalveolar lavage (BAL) revealed macrophages with lipid-filled vacuoles and negative periodic acid-Schiff (PAS) stain. Further history obtained from the patient and family was notable for daily application of commercially available vapor rub to nares and intentional deep inhalation of nebulized fluids containing scented oils. The patient was diagnosed with exogenous lipoid pneumonia through an unusual route of lipid administration.

Eosinophilic Chronic Obstructive Pulmonary Disease

Recent therapeutic advances in the management of asthma have underscored the importance of eosinophilia and the role of pro-eosinophilic mediators such as IL-5 in asthma. Given that a subset of patients with COPD may display peripheral eosinophilia similar to what is observed in asthma, a number of recent studies have implied that eosinophilic COPD is a distinct entity. This review will seek to contrast the mechanisms of eosinophilia in asthma and COPD, the implications of eosinophilia for disease outcome, and review current data regarding the utility of peripheral blood eosinophilia in the management of COPD patients.

722. Parasitic and Non-Parasitic Causes of Eosinophilia in Children Presenting to a Tertiary Care Center in the United States

Background Peripheral eosinophilia can be caused by many underlying conditions, including infectious pathogens, allergic disorders, neoplastic disorders, and immunological disorders. However, uncovering the cause of eosinophilia in children can be challenging due to the wide differential diagnosis. Methods To identify causes and risk factors of eosinophilia in children, we performed a retrospective chart review of children presenting to Texas Children’s Hospital in Houston, TX with peripheral eosinophilia from January 1, 2011 to December 31, 2019. Eosinophilia was classified as mild (absolute eosinophilia count or AEC >500 and < 1500), moderate (AEC >1500 and < 5000) and severe (AEC > 5000). Demographic information in addition to travel history, co-morbid conditions, and diagnostic workup were collected. Results A total of 773 patients under 18 years of age were evaluated. The most common cause of eosinophilia in children was atopy (N=343, 44%), followed by eosinophilia of unknown etiology (N=227, 29%). Infectious pathogens were the etiology in 8% of cases of which all were parasitic pathogens. Helminthic (n=48, 79% of parasitic diseases in total) pathogens were more common than protozoan (n=13, 21% of parasitic diseases in total) and patients with parasitic infections had higher median eosinophilia compared to other subgroups (median = 1661, range 512-17,501) with the majority having moderate to severe eosinophilia (57%). The most common helminth was Toxocara (n=31), followed by Strongyloides (n=15), and, more rarely, pinworms (n=4). The most common protozoa identified was Dientamoeba fragilis (n=9), followed by Giardia species (n=5), Endolimax nana (n=4), Blastocystis species (n=3), and Iodamoeba butschlii (n=1). Many unknown cases had limited workup that did not include investigations for common parasites. Conclusion While atopy and unknown etiology were the most common diagnoses for children presenting with eosinophilia, parasites were relatively common and should be considered in the differential when investigating etiologies for peripheral eosinophilia. Disclosures Joud Hajjar, MD, MS, Baxalta (Grant/Research Support)Horizon (Advisor or Review Panel member)Pharming (Advisor or Review Panel member)

GRANULOMATOSE EOSINOPHILIQUE AVEC POLYANGEITE: PRESENTATIONS INHABITUELLES. EOSINOPHILIC GRANULOMATOSIS WITH POLYANGIITIS: UNUSUAL PRESENTATIONS

Introduction:Eosinophilic granulomatosis with polyangiitis (EGPA) is a rare systemic vasculitis of unknown etiology, affecting small and medium-sized vessels and associating asthma,pulmonary involvement, peripheral eosinophilia and extravascular eosinophilic granulomas. We report three GEPA sightings of unusual revelations. Methods:These are three cases of GEPA from the internal medicine department B, Mohammed V military hospital in Rabat. Results:Three patients aged between 27 and 70 years. The most frequently found manifestations were pulmonary, cutaneous, neurological and digestive. All patients presented with peripheral eosinophilia. The ANCA were negative. All patients were treated with corticosteroids in one case, immunosuppressive therapy were used. Conclusion:In this article, GEPA was revealed by an acute surgical abdomen (appendicitis) in one case, a febrile rash in the second and liver damage in the third patient. Our patients responded well to corticosteroid therapy but the treatment must be adapted depending on the case.

DYSPLASTIC EOSINOPHILIA ASSOCIATED WITH STEROIDS

The bone marrow normally is influenced by certain drugs which may cause temporary suppression of the activity and with withdrawal of drugs can get reactivated. Generally, the bone marrow response to drugs and chemicals like chloramphenicol, pesticides and methotrexate are bit predictable and can be detected easily. However, drugs like steroids which are also immunomodulators, the response may not be obvious initially and during the course of time can be detected in an odd way. Two patients who were on steroids had peripheral eosinophilia with evidence of certain degree of dysplasia involving eosinophilic lineage of myeloid series are noted.