Abstract
Objective: We describe cases of Late-onset hypereosinophilic asthma (LHEA) accompanied by systemic eosinophilic manifestations (SEM), and discuss the possibility that LHEA can manifest as a systemic eosinophilic disease.
Methods: Retrospective survey of medical records identified 32 cases of LHEA. Fifteen of 32 patients with LHEA had SEM. Clinical features of those patients were reviewed.
Results: The subjects included 4 men and 11 women with a mean age of 43.7 years at the onset of asthma. All patients had eosinophilic sinusitis. Eosinophilic pneumonia (EP), eosinophilic gastroenteritis (EG), association of EP and EG, and association of EP and eosinophilic otitis media were seen in 5, 5, 1, and 4, respectively. The mean duration between onset of asthma and onset of SEM was 12.0 years, ranging from 0 to 44 years. The radiologic findings of EP were faint ground glass opacities on chest CT. These SEM appeared with marked peripheral blood eosinophilia and elevation of serum IgE levels. These manifestations responded well to systemic corticosteroid therapy, but there were frequent relapse and asthma exacerbations requiring continuous low-dose systemic corticosteroid therapy. Clinical and laboratory findings of vasculitis, such as cardiac involvement, peripheral neuropathy, and serum myeloperoxidase- and proteinase 3- anti-neutrophil cytoplasmic antibodies were not evident.
Conclusion: These characteristic features differ from those of known eosinophilic lung diseases, such as chronic EP, allergic bronchopulmonary mycosis, and eosinophilic granulomatous polyangitis. We would like to propose the concept of LHEA with accompanying SEM.
- Copyright ©the authors 2016
