Eosinophilia and Hypogammaglobulinemia in response to Mesalamine

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 (symptoms).

Warm regards,

JoelP

[joelp]

This story has a very happy ending. 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, ground glass opacities.  I developed a persistent dry cough.  sudden onset Asthma.  Histology showed focal necrosis of the colon with eosinophilic infiltrates through all levels of the mucosa.  Months later, I started to develop tingling in extremities, shooting pains in hips and joints.


-­ Cardiologist saw no Eosinophilic infiltration or Loeffler’s.

- Repeated Endoscopies show no problems. I am negative for Eosinophilic Gastroenteritis.

-­ A number of separate 3 day stool test for parasites came up negative.

-­ Hematologist did bloodwork and Bone Marrow biopsy, but sees no sign of neoplastic disease.



My internist felt very uncomfortable with two concurrent diagnoses of very rare disorders (Eosinophilia and Hypogammaglobulinemia).



I am now Cured, as of October 2009.  I had developed the signs of Churg-Strauss: Persistent high Eosinophilia (27%-48%) for more than six months, tingling in extremities, shooting pains in hips and joints, migrating ground glass opacities in the lungs as well as lung granulomas, lung nodules, sudden onset Asthma and focal necrosis of the colon with eosinophilic infiltrates through all levels of the mucosa.  Before being put on Steroids by my Rheumatologist, I was sent to an Infectious Disease expert.  Even though I tested negative to Parasites many times, I was given one dose of Ivermectin (a broad-spectrum Antihelminthic (paralyzes and eliminates parasites)).  All symtoms (symptoms) disappeared and the Eosinophil level returned to 5%.  This was tested monthly for three months.  It was apparently a parasite that evaded tests, generating a range of rheumatological symtoms (symptoms).  Even my low IGG has been gradually returning to normal levels.


Anyone with a preliminary diagnosis of Idiopathic Hypereosinophilia or Churg-Strauss Syndrome should undergo one treatment with Ivermectin, to rule out a hidden parasitic infection.  Especially since treatment for Churg-Strauss involves steroidal immunosuppresent therapy that could prove fatal in the presence of a parasite such as Strongyloides, as autoinfectious parasites such as Stronglyloides florish when the immune system is repressed, leading to rapid infection in atypical organs leading to organ failure.

Joel P.