Eosinophilia and Hypogammaglobulinemia in response to Mesalamine

[joelp]

Thanks in advance for your insight and guidance.  In March I suddenly found myself with a range of new diagnoses after being completely healthy 45 year old male with no medical history. In March 2009 I was diagnosed with Eosinophilia (40%), Hypogammaglobulinemia low IgG (407) after going to the doctor with stomach pain and alcohol intolerance (0.5 ounce of wine or whiskey would trigger a violent attack within minutes, while grape juice does not cause an attack).  Asthma (85% lung capacity), lung granulomas, lung nodules and possible mild Bronchiectasis.  

This all occurred after starting a 30 day course of Canasa (Mesalamine) to which I had rash and breathing problems in what seems to have been an allergic reaction and possibly triggered the above problems.

­ I am now on Claritin (10mg), Lexapro (5mg) and Aciphex which together brought relief to stomach pain within hours.
­ Cardiologist sees no Eosinophilic infiltration or Loeffler’s.  
­ Repeated Endoscopies show no problems.  I am negative for Eosinophilic Gastroenteritis.
­ 3 day stool test for parasites came up negative.
­ Hematologist did bloodwork and Bone Marrow biopsy, but sees no sign of neoplastic disease.

Combining this with the gastric disturbance/attacks (with instant continual relief with Claritin), alcohol intolerance, lung granulomas, lung nodules, sudden onset Asthma, all right after a reaction to Canasa, is an quite a set of symptoms that I think merits a 2nd opinion before going down steroids to control Eosinophilia and/or regular IV Immonoglobulin for the low IgG (note I do not get infections).

My internist feels very uncomfortable with two concurrent diagnoses of very rare disorders (Eosinophilia and Hypogammaglobulinemia).   Thoughts?  Suggestions?

Warm regards, thanks in advance,

[Dr_Subir]

Very unusual and thought provoking. It does give a picture of Type I and Type III hypersensitive reactions concurrently. What I will suggest is to check a blood test done to see if there is a defeciency of any complement factor. Please keep me updated.

[joelp]

Dr. Subir,

Thanks for your suggestions.  Please see the following interesting article:
http://content.karger.com/ProdukteDB/produkte.asp?typ=pdf&doi=29341

What intruiged me was the diffuse ground glass opacities in the CAT scan of lungs in this case.  I have the same issue.  This case also started with the same bowel symtoms.

Warm regards,

JoelP