This document discusses a case of hypereosinophilia in a 72-year-old man who presented with a neck mass. Differential diagnoses included malignancy, tuberculosis, Kimura's disease, and allergy/atopy. Testing found elevated eosinophil levels, IgE, and nasal masses. Biopsy of the nasal mass indicated undifferentiated carcinoma. The patient was diagnosed with NPC stage 4 associated with hypereosinophilia and drug eruption. Treatment with corticosteroids reduced eosinophil levels and symptoms. The document then reviews eosinophil production and functions, definitions of eosinophilia, and discusses differential diagnoses and approaches to patients with hypereosinophilia.

1. HIPEREOSINOFILIA
EVALUASI DAN DIAGNOSIS BANDING KASUS DENGAN HIPEREOSINOFILIA

2. Pendahuluan
• Penyebab hipereosinofila bervariasi
• Infeksi, alergi hingga penyakit yang jarang
• Pengenalan diagnosis banding perlu untuk mengarahkan
diagnosis dan terapi

3. Kasus
• Laki laki 72 th
• Keluhan benjolan di leher 1 thn
• B symptom (+)
• Batuk (-) sesak (-)
• Diare (-)
• TB kelenjar  OAT  alergi

4. Kasus
• Vital sign normal
• Edem palpebra unilateral
• Polip/masa cavum nasal
• Masa di coli dextra disertai pembesaran lnn multipel di colli
• Px paru, jantung, abdomen dbn
• Kulit : skuama (+)

5. Foto klinis

6. Foto klinis

7. Kasus
• Hb :11,1
• AL : 16,4
• Eosinofil % : 54%
• Eosinofil # : 6120
• IgE total 185,9 kUI/L (normal < 100)
• Fungsi ginjal, liver normal
• Feses normal

8. Rontgen Thorax
• Mengarah gambaran TB
pulmo bilateral dengan
tenting diafragma dextra
• Besar cor normal

9. Differential diagnosis ???
• Malignancy ?
• TB ?
• Kimura?
• Alergi / atopi ?

10. MSCT kepala leher
• Mengarah gambaran NPC dextra
yang mendestruksi dan meluas ke
sinus maxilaris dextra, cavum nasi
dextra, ethmoidalis dextra,
sphenoidalis serta ke intracranial
dan intracerebral di lobus temporalis
• Limfadenopati cervicalis dextra

11. Biopsi nasal
• Sediaan mennjukan jaringan nasofaring dengan tumor tersusun
solid menginfiltrasi jaringan ikat sekitarnya.
• Sel sel polimorfi berukuran sedang sampai besar, sitoplasma
sedikit, inti bulat, oval, spindel, kromatin kasar, sebagian
hiperkromasi, sebagian vesikuler dengan anak inti prominen.
• Stroma dengan pembuluh darah dilatasi dan ekstravasasi eritrosit
disebuk limfosit cukup
• Kesimpulan :
massa cavum nasi dextra: undifferentiated carcinoma

12. AJH regio colli
• Banyak sel radang yang tersebar terdiri atasbanyak limfosit,
histiosit epiteloid, lekosit pmn, denganlatareritrosit merata dan
massa amorf
• Tidak ada sel ganas
• Radang granulomatosa, masih mungkin infeksi TB
• Saran: biopsi

13. Biopsi massa colli
• Belum ada hasil

14. Diagnosis akhir
• NPC stadium 4
• Hipereosinofilia related malignancy
• Riw drug eruption ec OAT

15. Terapi
• Inj. dexametason 1A/8 jam
• Interhistin 1x1

16. Foto klinis
Sebelum tx corticostreoid Setelah tx corticostreoid

17. Foto klinis
Sebelum tx corticostreoid Setelah tx corticostreoid

18. Kasus
• Hb :11,1  8,3
• AL : 16,4  11,3
• Eosinofil % : 54%  0%
• Eosinofil # : 6120  0

19. PEMBAHASAN

21. Kita H. et al.Middleton's Allergy ; 8th edition. 2014. p. 265-79

22. Eosinophil:Production
• Hematopoietic factors for eosinophil production &
differentiation
- IL-3
- IL-5
- GM-CSF
Kita H. et al.Middleton's Allergy ; 8th edition. 2014. p. 265-79

23. Kita H. et al.Middleton's Allergy ; 8th edition. 2014. p. 265-79

24. Kita H. et al.Middleton's Allergy ; 8th edition. 2014. p. 265-79

25. Kita H. et al.Middleton's Allergy ; 8th edition. 2014. p. 265-79

26. Kita H. et al.Middleton's Allergy ; 8th edition. 2014. p. 265-79

27. Kita H. et al.Middleton's Allergy ; 8th edition. 2014. p. 265-79

28. Kita H. et al.Middleton's Allergy ; 8th edition. 2014. p. 265-79

29. Kita H. et al.Middleton's Allergy ; 8th edition. 2014. p. 265-79

30. Ackerman SJ, Bochner BS. Mechanisms of eosinophilia in the pathogenesis of hypereosinophilic disorders.
Immunology and allergy clinics of North America. 2007;27(3):357-75.

33. Definition
Eosinophilia
Blood eosinophil count exceeding 500 cells/microliter
Severity of eosinophilia
• Mild eosinophilia 500 to 1,500 cells/microliter
• Moderate eosinophilia 1,500 to 5,000 cells/microliter
• Severe eosinophilia > 5,000 cells/microliter
Roufosse F, Weller PF. Practical approach to the patient with hypereosinophilia. The Journal of allergy and
clinical immunology. 2010;126(1):39-44.

35. Klion AD. et al.Middleton's Allergy ; 8th edition. 2014. p. 1205-23.

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