Eosinophils infiltration

Th2 lymphocytes are one of the primary factors initiating and perpetuating the inflammatory response.7 In addition, proinflammatory mediators such as the leukotrienes generated during mast cell degranulation can increase vascular permeability, leading to airway edema and increased mucus production.8 Eosinophilic infiltration of the airways is a hallmark of asthma, and activated eosinophils can cause bronchoconstriction and AHR.9... 

Eosinophil infiltration is a major feature of asthma and allergic reactions [203], These cells are not abundant during the acute phase of the response, but increase in number and account for 10-80% of the total cell infiltrate during the late phase. Furthermore, major basic protein (MBP), which is released from eosinophil granules, causes respiratory epithelial damage [204]. Since PAF is a potent activator of eosinophil functions [205], BN 52021 may interfere with the late phase response. 

An open study has also shown that 1 month s treatment of severe asthmatic patients with BN 52063 improves both FEV1 and inhibits eosinophil infiltration induced by PAF in the skin test [188]. In another study, severely asthmatic children were treated with the Ginkgo extract, GBE 761 (1 drop/kg three times a day). Complete recovery was observed in 60% of the children as determined by both clinical and spirometric (FEV1) parameters. Of the remainder, 30% showed moderate improvement and only 10% were resistant to therapy [ 188],... 

Liver biopsies showing bile plugs in the canaliculi, with eosinophilic infiltration in the periportal space... 

Association with peripheral eosinophilia and eosinophilic infiltrations in the liver... 

A skin biopsy from a 58-year-old man showed necrosis of keratinocytes with lymphocytic and eosinophilic infiltration. Liver enzymes were normal. After withdrawal the rash disappeared. After 3 weeks, rechallenge with acarbose 50 mg caused the skin changes to reappear. 

Eosinophilic infiltrations have been described with tolbutamide (SEDA-8, 917 90), and chronic eosinophilic pneumonia has been described with chlorpropamide (91) and tolazamide (92). 

Lee YL, Fu CL, Ye YL, Chiang BL Administration of interleukin-12 prevents mite Der p 1 allergen-IgE antibody production and airway eosinophil infiltration in an animal model of airway inflammation. Scand J Immunol 1999 49 229-236. 

Coyle, A. J., Wagner, K Bertrand, C Tsuyuki, S Bews, J., and Heusser, C. (1996) Central role of immunoglobulin (Ig) E in the induction of lung eosinophil infiltration and T helper 2 cell cytokine production inhibition by a non-anaphy-lactogenic anti-IgE antibody. J. Exp. Med. 183, 1303-1310. 

There has been a previous report linking venlafaxine to pneumonia associated with eosinophilic infiltration, and SSRIs have been associated with drug-induced infiltrative lung disease. 

Morokata T, Suzuki K, Ida K, Yamada T. Effect of a novel interleukin-5 receptor antagonist, YM-90709, on antigen-induced eosinophil infiltration into the airway of BDFl mice. Immunol Lett. 2005 98 161-165. 

Liver biopsy is of only limited use in diagnosis, although certain features, e.g. eosinophil infiltration, may provide a pointer to drug-induced liver disease. 

Eosinophilic infiltrations in the portal fields generally point to intrahepatic cholestasis. By contrast, ductular changes with bile cylinders, ballooning, acidophilia of the liver cells at the lobular centres, bile infarcts, increase in the copper content, etc. are usually signs of extrahepatic cholestasis, (s. fig. 13.5) (s. tab. 13.10)... 

A 66-year-old man had taken trovafloxacin 100 mg/day for 4 weeks for refractory chronic sinusitis (10). For several years he had also taken allopurinol, doxepin, hydrochlorothiazide, losartan, metoprolol, and nabumetone. He developed nausea, vomiting, malaise, and abdominal distension. His white cell count was 8000 x 10 /1 with 16% eosinophils his serum aspartate transaminase was 537 IU/1, alanine transaminase 841 IU/1, direct bilirubin 17 pmol/l total bilirubin 27 pmol/l, alkaline phosphatase 111 IU/1 blood urea nitrogen 5 pmol/l and creatinine 190 pmol/l. Tests for hepatitis A, B, and C were negative. A biopsy of the liver showed centrilobular and focal periportal necrosis and eosinophilic infiltration the sinusoids were dilated and contained lymphocytes and eosinophils many hepatocytes were undergoing mitosis. After withdrawal of trovafloxacin and treatment with prednisone, his hepatic and renal function returned to normal, and the eosinophilia gradually resolved. 

Aldesleukin-induced cardiac eosinophilic infiltration has been reported (27). 

After 25 days of treatment with continuous aldesleukin infusion (up to 150 000 units/kg/day) for stage IV Hodgkin s disease, a 26-year-old woman had increased fatigue, tachycardia, hypotension, and hypothermia. Echocardiography showed bilateral intraventricular masses. Her maximal absolute eosinophil count was 11.4 X 10 /1 and the platelet count was 17 x 10 /1. Despite aldesleukin withdrawal, her condition deteriorated and she died. Postmortem examination showed biventricular thrombi and prominent eosinophilic infiltration of the endomyocardium. 

Advisory Committee (ADRAC) there were 15 cases of myocarditis (five fatal) and 8 of cardiomyopathy (one fatal) associated with clozapine. All cases of myocarditis occurred within 3 weeks of starting clozapine. Cardiomyopathy was diagnosed up to 36 months after clozapine had been started. There were no confounding factors to account for cardiac illness. Necropsy results showed mainly eosinophilic infiltrates with myocytolysis, consistent with an acute drug reaction. 

Eosinophilic gastroenteritis after enalapril has been described (13). The authors briefly reviewed this rare condition, which is diagnosed on the basis of the presence of gastrointestinal sjmiptoms, eosinophilic infiltration of the gastrointestinal tract, and the absence of parasitic or extra-intestinal disease. It has also been reported after clofazimine and naproxen. 

A 44-year-old woman developed acute hepatitis while taking gatifloxacin for chronic sinusitis (23). After 5 days she developed nausea, lethargy, and abdominal pain, all of which progressed over the next few days. Liver function tests were abnormal, and the bilirubin peaked at 161 pmol/l. A percutaneous liver biopsy showed acute hepatitis with eosinophilic infiltrates, consistent with drug-induced hepatitis. 

Cooper PJ, Beck LA, Espinel I, Deyampert NM, Hartnell A, Jose PJ, Paredes W, Guderian RH, Nutman TB. Eotaxin and RANTES expression by the dermal endothelium is associated with eosinophil infiltration after ivermectin treatment of onchocerciasis. Clin Immunol 2000 95(1 Pt 1) 51-61. 

A 53-year-old Japanese man, who had taken skullcap intermittently for hemorrhoids, developed recurrent interstitial pneumonitis (17). Re-challenge, after he had stopped taking the herbal remedy and had become symptom free, resulted in a high fever and signs and symptoms of interstitial pneumonitis. Transbronchial lung biopsy showed Ijmphocytic alveolitis with eosinophilic infiltration. The symptoms subsided again after withdrawal. 

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