Child 28% Eosinophils

[zasmom]

Hi. My family and I have been going through a nightmare of testing. Our son has been limping for quite a few years-it seems to be exercise related. He seems to become fatigued and his left leg begins to weaken, causing him to limp. We took him to a orthopaedic specialist at our local children's hospital. The doctor ran a CBC with differential and suspects he may have a mild form of muscular dystrophy so performed a MDM as well (the results are not yet in). The CBC showed high Eosinophils, high Basophils, and low lymphocytes. We were told that it is likely allergy related and to follow up with the family doctor. We followed up with the doctor and a stool sample and abdominal x-ray were done. The stool sample was negative for parasites and the abdominal x-ray showed moderate stool-unremarkable were the remarks. 3 weeks after the initial CBC, the family doctor performed a repeat CBC and liver enzymes. The Eosiniophils were now even higher at 28%! Needless to say we are frustrated. His AST was mildly elevated at 47 (43 at the initial test). I've read that the AST is not always related to the liver but relates to the heart as well. His doctor mentions that he also has pre-hypertension but I don't get it because his blood pressure is generally always 95/64 or so but because he is being tested for Muscular Dystrophy and I know that heart conditions can be associated with Muscular Dystrophy, I am terrified that his AST is elevated and that his doctor says he has pre-hypertension. I don't buy that he has high blood pressure but I am not a doctor. The Eosinophils are of particular concern. Can someone please please please help me with this? We are going to an immunologist tomorrow at our children's hospital but I want to be sure I'm not taking the wrong road. I am fearful something is wrong with his heart but I am hoping that this level of Eosinophils (28.3%-{WBC 9000}) could be an allergy that can be treated. Thanks

[National Jewish Health]

What you describe suggests that your son may have hypereosinophilic syndrome (HS).  Elevation of the liver enzyme aspartate aminotransferase (AST) can occur in this condition, when there is heart involvement and can also be seen with muscular dystrophy (MD).  However, with the normal AST range of 8 to 39, a value of 47 might still be in the normal or certainly near-normal range, especially considering elevations of several hundred in a number of disease states.  In essence, please do not make too much of the AST of 47.  Were the AST elevation due to MD, one would also expect an elevation of creatine phosphokinase (CPK), an enzyme that is contained in skeletal and cardiac muscle.

HS is a heterogeneous group of diseases.  Therapy with corticosteroids is used for the treatment of most and additional therapy is available and dependent upon the type of HS.  Newer medicines such as imatinib and mepolizumab are said to be promising.  So, should your son have HS, there is reason to be optimistic regarding a positive response to currently available therapy.

You should request, of his doctor, an additional explanation for the tentative diagnosis of pre-hypertension.

Good luck.

[zasmom]

Thank you for your thorough response. One item I failed to mention is that I have read Eosinophilia can be an indicator of Muscular Dystrophy. Please respond if you have knowledge of Eosinophilia being associated with certain types of Muscular Dystrophy. Last, the immunologist (Dr. Lierl of Cincinnati Children's Hospital) found allergy to mold and tree pollen although states that there are currently no allergens in the air that could be contributing to the Eosinophil level. I trust her opinion but am hoping for additional insight in regard to that area.

Thank you for your time and input.

Sincerely