How I Do It: Approach to Eosinophilia Presenting with Pulmonary Symptoms.

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Eosinophilia with pulmonary involvement is characterized by the presence of peripheral blood eosinophilia, typically ≥500 cells/mm3; pulmonary symptoms and physical exam findings, which are nonspecific; radiographic evidence of pulmonary disease; and is further supported by histopathologic evidence of tissue eosinophilia in a lung or pleura biopsy specimen and/or increased eosinophils in bronchoalveolar lavage fluid, usually > 10 percent. Considering that there are a variety of underlying etiologies of eosinophilia with pulmonary manifestations and overlapping clinical, laboratory and radiologic features, it is essential to systematically approach the evaluation of eosinophilia with pulmonary findings. In this review, we will describe a case presentation, discuss the differential diagnosis, a directed approach to the diagnostic evaluation and supporting literature, and current treatment strategies for pulmonary eosinophilia syndromes and levels of evidence underlying the recommendations, where available. Overall, optimal management of eosinophilic lung disease presentations are directed at the underlying etiology when identifiable and the urgency of treatment may be guided by the presence of severe end-organ involvement or life-threatening complications. When an underlying cause is not easily attributable, management of eosinophilia with pulmonary involvement largely relies on eosinophil-directed interventions, for which biologic therapies are increasingly being used.

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