An Unusual Cause of Eosinophilia - Hypereosinophilia Due to Contact Dermatitis
Sunday, March 6, 2016
South Exhibit Hall H (Convention Center)
Prathyusha Savjani, MD
Rationale: Contact dermatitis is an uncommon cause of peripheral eosinophilia. We present a case of a young woman with hypereosinophilia following severe contact dermatitis of a cesarean section wound.

Methods: Evaluation of this patient included a CBC, CMP, serum total IgE, B12, tryptase, antibody titers to toxocara, strongyloides, and schistosoma, HIV antibodies, peripheral blood flow cytometry to look for T-cell or B-cell receptor gene rearrangement or a CHIC2 gene deletion c/w FIP1L1-PDGFRA rearrangement.

Results: A 31 year-old Caucasian woman with history of mild allergic rhinitis and no other medical conditions was referred for hypereosinophilia. Eosinophilia was first noted during evaluation of severe contact dermatitis of her caesarian section incision site possibly from betadine or steri-strips. Initial eosinophil counts were as high as 16,000/uL. She was treated with oral prednisone leading to improvement of her dermatitis, but with persistent peripheral eosinophilia with counts reaching 400/uL. Eosinophilia persisted for many months, and 1 year later while on low dose prednisone treatment with 2.5 mg q.o.d., her eosinophil count is 990/uL. A thorough evaluation was performed as described in the methods section without identifying a causative etiology.

Conclusions: We believe this is a case of hypereosinophilia secondary to severe contact dermatitis. The etiology of eosinophilia in many cases remains unknown and such cases are often classified as idiopathic hypereosinophilia. However, many of these cases may actually have an instigating cause and contact dermatitis should be considered in the appropriate clinical setting.