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Differenzialdiagnose der Hypereosinophilie

Differential diagnosis of hypereosinophilia

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Zusammenfassung

Als Eosinophilie bezeichnet man eine Erhöhung der absoluten Eosinophilenzahl und unterscheidet hierüber auch bezüglich der Schwere. Die häufigsten Ursachen sind allergische (auch Medikamentennebenwirkungen) und infektiöse Auslöser, aber auch maligne und autoimmune Erkrankungen können mit einer Eosinophilie einhergehen. Ausgeprägte Eosinophilien mit Eosinophilenzahlen >5000/µl finden sich meist bei myeloproliferativen Erkrankungen, der eosinophilen Granulomatose mit Polyangiitis (EGPA) und bei Gewebsmigration von Gewebeparasiten. Als hypereosinophiles Syndrom bezeichnet man eine über 6 Monate bestehende Eosinophilie mit >1500 Eosinophilen/µl bei Ausschluss einer Parasitose, Allergie oder anderer Ursache und Zeichen einer Gewebeeosinophilie mit Endorganschädigung. Zur Abklärung sollten bei persistierender Eosinophilie neben einer genauen Anamnese und körperlichen Untersuchung auch früh ein Organscreening, eine Wurmdiagnostik sowie eine hämatologische Labordiagnostik inklusive Knochenmarkuntersuchung erwogen werden.

Abstract

Eosinophilia is defined as an elevated absolute number of eosinophilic leukocytes in peripheral blood or tissue. Its absolute number also defines the grade of eosinophilia. The main causes are allergic (including drug side effects) and infectious triggers but malignant and autoimmune diseases can also result in eosinophilia. Severe eosinophilia with the number of eosinophils >5000/µl are mostly caused by myeloproliferative disorders, eosinophilic granulomatosis with polyangiitis or during tissue migration in parasitic tissue infections. Hypereosinophilic syndrome is defined as eosinophilia with >1500 eosinophils/µl and a duration of more than 6 months by exclusion of parasitic infections, allergies or other causes of tissue eosinophilia with end-organ damage. For the diagnosis of a persistent eosinophilia a detailed medical history and physical examination should be followed by early organ screening, infection diagnostics especially for helminth infections and hematological laboratory analyses including bone marrow investigations.

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Authors and Affiliations

  1. Zentrum für Interdisziplinäre Klinische Immunologie, Rheumatologie und Autoimmunerkrankungen (INDIRA), Universitätsklinikum, Otfried-Müller-Str. 10, 72076, Tübingen, Deutschland

    J. C. Henes

  2. Medizinische Klinik II (Onkologie, Hämatologie, Klinische Immunologie, Rheumatologie und Pulmologie), Universitätsklinikum Tübingen, Tübingen, Deutschland

    J. C. Henes &  S. Wirths

  3. Vaskulitiszentrum-Süd, Klinik für Innere Medizin, Rheumatologie und Immunologie, Medius Kliniken, Akademisches Lehrkrankenhaus, Universität Tübingen, Kirchheim u. Teck, Deutschland

    B. Hellmich

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  1. J. C. Henes
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  2. S. Wirths
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Correspondence to J. C. Henes.

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Interessenkonflikt

J.C. Henes, S. Wirths und B. Hellmich geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Redaktion

B. Hellmich, Kirchheim-Teck

F. Moosig, Neumünster

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Henes, J.C., Wirths, S. & Hellmich, B. Differenzialdiagnose der Hypereosinophilie. Z Rheumatol 78, 313–321 (2019). https://doi.org/10.1007/s00393-018-0587-2

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  • DOI: https://doi.org/10.1007/s00393-018-0587-2

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