Patient Presentation
A 13 month old male was referred to hematology after his screening complete blood count at 12 months of age showed eosinophila.
He was well other than severe atopic dermatitis for which he was receiving tacrolimus, steroids and emollients on his skin.
The past medical history revealed no pet exposure, no travel history for the patient or contacts, no bronchiolitis or pulmonary disease and he was taking no other medication. The patient did have mild intermittent rhinorrhea consistent with upper respiratory infections in the past.
The family history showed intermittent asthma in a sibling and an aunt with arthritis, but no other pulmonary or autoimmune diseases.
The review of systems showed no vomiting/diarrhea, fever/chills, or other symptoms.
The pertinent physical exam revealed a child with normal growth parameters and extensive dermatitis involving the face, neck, trunk and extremities. He had no adenopathy or hepatosplenomegaly. He had no other rashes.
The laboratory evaluation showed his complete blood count at 12 months of age to have a white blood count of 8.4 x 1000/mm2 with 4500 polymorphonuclear cells, 1600 lymphocytes and 2300 eosinophils.
In the clinic, his complete blood count was similar except that his eosinophils had decreased to 1400.
The diagnosis of eosinophila secondary to atopic dermatitis was made. He was to follow-up with his primary care physician to monitor the eosinophila which should improve with improved control of his atopic dermatitis.
Discussion
Screening tests for occult disease are an important part of maintaining health but sometimes have unexpected results which must be addressed. The screening recommended tests vary by age and risk factors and the recommendations do change over time based upon new evidence.
Currently, the Bright Futures: Guidelines for Health Supervision of Infants, Children and Adolesents has recommendations for hearing, vison, iron-deficiency anemia, elevated blood lead levels, hyperlipidemia, hypertension, sexually transmitted diseases and other topics.
They can be found at the Bright Futures website.
Learning Point
Eosinophilia in children is commonly caused by allergic, immunologic or parasitic problems.
Causes of eosinophila include:
- Allergic disease
- Asthma
- Seasonal or chronic rhinitis
- Urticaria
- Dermatologic disease
- Atopic dermatitis
- Pemphigus
- Dermatitis herpetiformis
- Immunologic disease
- Dermatomyositis
- Eosinophilia fascitis
- Hyperimmunoglobulinemia E
- Hypersensitivity vasculitis
- IgA Deficiency
- Inflammatory bowel disease
- Polyarteritis nodosa
- Scleroderma
- Wegener’s granulomatosis
- Wiskott-Aldrich syndrome
- Parasitic disease
- Ascariasis
- Amebiasis
- Filariasis
- Hookworms
- Pneumocystis carinii
- Scabies
- Schistosomiasis
- Toxoplasmosis
- Trichonosis
- Visceral larva migrans
- Other Infectious disease
- Aspergillosis
- Cat scratch disease
- Coccidiomycosis
- Histoplasmosis
- Medication
- Ampicillin
- Arsenics
- Gold
- Iodide
- Nitrofurantoin
- Para-aminosalicylic Acid
- Phenothiazines
- Phenytoin
- Sulfonamid
- Streptomycin
- Hematologic disease
- Chronic myeloproliferative states
- Fanconi’sanemia
- Hereditary eosinophilia
- Post-splenectomy
- Thrombocytopenia, absent radius syndrome
- Malignancies
- Adenocarcinoma
- Brain tumors
- Epidermoid carcinoma
- Lymphomas
- Post-radiation therapy
- Other
- Chronic peritoneal dialysis
- Congenital heart disease
- Loeffler syndrome (i.e. Pulmonary eosinophilia)
Questions for Further Discussion
1. What are the causes of basophilia?
2. What other laboratory abnormalities are common with parasitic infections?
Related Cases
- Symptom/Presentation
- Specialty
- Age
To Learn More
To view pediatric review articles on this topic from the past year check PubMed.
Information prescriptions for patients can be found at MEDLINEplus for this topic: Eczema
To view current news articles on this topic check Google News.
Bakerman S. Bakerman’s ABC’s of Interpretive Laboratory Data. 3rd edit. Interpretive Laboratory Data, Myrtle Beach SC. 1994;540.
Stockman JA, Corden TE, Kim JJ. The Pediatric Book of Lists. Mosby-Year Book. 1991:163-4.
ACGME Competencies Highlighted by Case
2. Essential and accurate information about the patients is gathered.
3. Informed decisions about diagnostic and therapeutic interventions based on patient information and preferences, up-to-date scientific evidence, and clinical judgment is made.
8. Health care services aimed at preventing health problems or maintaining health are provided.
9. Patient-focused care is provided by working with health care professionals, including those from other disciplines.
10. An investigatory and analytic thinking approach to the clinical situation is demonstrated.
11. Basic and clinically supportive sciences appropriate to their discipline are known and applied.
13. Information about other populations of patients, especially the larger population from which this patient is drawn, is obtained and used.
24. Cost-effective health care and resource allocation that does not compromise quality of care is practiced.
Author
Donna M. D’Alessandro, MD
Associate Professor of Pediatrics, Children’s Hospital of Iowa
Date
May 1, 2006
Pediatric Education 