SHM Converge Scientific Abstract ePoster Gallery-Profound Hyper-Eosinophilia Diagnosis by Biopsy: A Case Report

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This case report describes a 44-year-old man with a history of sarcoidosis who presented with 10 days of shortness of breath, dry cough, and headaches. He did not improve after amoxicillin-clavulanate and had diffuse wheezing, tachycardia, hepatomegaly, marked leukocytosis, and profound eosinophilia. His absolute eosinophil count rose dramatically, peaking at 45,510/µL, while white blood cells peaked at 63,000/µL.<br /><br />Initial imaging was unrevealing on chest X-ray, but CT of the chest showed bilateral bronchiectasis, bronchial wall thickening, and mucus plugging. Extensive infectious, allergic, immunologic, rheumatologic, and hematologic testing was negative, helping narrow the differential. Because his symptoms persisted despite inhaled bronchodilators and the diagnosis remained unclear, he underwent VATS lung biopsy.<br /><br />Biopsy demonstrated eosinophilic bronchiolitis with mild respiratory bronchiolitis, establishing the diagnosis. The report highlights hyper-eosinophilic obliterative bronchiolitis/eosinophilic bronchiolitis as a rare small-airway disease that can mimic asthma with cough, wheezing, and dyspnea but requires different treatment. Diagnosis often depends on bronchoalveolar lavage or lung biopsy, especially when blood eosinophilia is extreme and other causes have been excluded.<br /><br />Treatment generally involves prolonged systemic corticosteroids, and biologic therapies targeting eosinophilic inflammation may be considered in some cases. The authors emphasize that this case illustrates the importance of maintaining a broad differential diagnosis and involving multiple specialties when evaluating severe eosinophilia with pulmonary symptoms.

Asset Subtitle

Bethany Korom

Meta Tag

Author List Bethany Korom, Bipin Thapa, Ryan Shields

Category Clinical Vignettes

Concept Hypereosinophilia

Concept Eosinophilic bronchiolitis

Concept Differential Diagnosis

Concept Absolute Eosinophil Count

Concept Systemic Corticosteroid

Distinguished Non-Finalist

Presenter Organization Children's Hospital of Wisconsin

Presenting Author Bethany Korom

Track Adult

Keywords

eosinophilic bronchiolitis

hypereosinophilia

sarcoidosis

dyspnea

wheezing

bronchiectasis

lung biopsy

bronchoalveolar lavage

systemic corticosteroids

pulmonary eosinophilia

Hypereosinophilia

Eosinophilic bronchiolitis

Differential Diagnosis

Absolute Eosinophil Count

Systemic Corticosteroid