1 / 13

Interesting case CT 50 YO Jaundice

Interesting case CT 50 YO Jaundice . Dr.Whitecar BMHGT 1/28/09. Eosinophilia (AEC>600). 3 CYTOKINE PATHWAYS FOR TRIGGER(production and longevity) IL5; IL3 AND GM-CSF Chemokines for migration Primary and secondary Clonal and idiopathic (HES) CEL chronic eosinophilic leukemia.

taryn
Download Presentation

Interesting case CT 50 YO Jaundice

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Interesting caseCT 50 YO Jaundice Dr.Whitecar BMHGT 1/28/09

  2. Eosinophilia (AEC>600) • 3 CYTOKINE PATHWAYS FOR TRIGGER(production and longevity) • IL5; IL3 AND GM-CSF • Chemokines for migration • Primary and secondary • Clonal and idiopathic (HES) • CEL chronic eosinophilic leukemia

  3. Secondary Causes • Atopy –asthma • Diet and medication allergy • Helmenthic and fungal conditions • Drug reactions • Lymhomnas ; gastric/lung Ca(para); HTLV1; ATLL • Addison ‘s disease • RA;Toxic oil; CS vasculitis; trypto myalgia

  4. CEL –chronic eosinophilic leukemia • Cytogenetic or molecular evidence of Clonal nature • Peripheral Blasts >2% • Bone marrow blasts >5% <19% • Other causes excluded • Ch-4q12 deletion ; FIP1L1-PDGFRA • CH1C2; BCR-PDGFRA&b; FGFR1 MUTATIONS

  5. Hyper-eosinophilic Syndromes ( HESs) • Older terminology-idiopathic;loeffler • HESs- Chusid criteria • AEC >1500 • >6 months of hypereosinophilia • Organ involvement • Absence of allergic or parasitic conditions

  6. Organ involvement • Blood 100% • 58% cardiac • Skin 56% • Neuro;lung 50% • Spleen 43% • Liver 30% • Ocular 23%-50%

  7. Cardio-pulmonary manifestations • Endomyocardial (subtle) • Thrombotic • Fibrotic---CHF • Same 3 stages seen in other diseases with increased Eosinophils ( parasitic ) • Cough; lung infiltrates and fibrosis

  8. GI Manifestations • Chronic active hepatitis • Budd Chiari like picture • Colitis • Esophagitis gastritis • Gastro enteritis

  9. Ocular and Neurologic • Blurry vision • Choroidial abnormalities ( upto 50%) • Primary CNS or peripheral NS • Neuropathy • Thromboembolic phenomenon

  10. Hematologic (100%) • Anemia • Low platelets • High platelets • Lymphadenopathy • Eosinophilia • Hypersplenism with painful enlarged spleen

  11. Myeloproliferative variant • Affects males • FIP1L1-PDGFR ALPHA FUSION GENE MUTATION positive (+) • INCREASE B12; TRYPTASE • CARDIAC INVOLVEMENT • IMATINIB IS Rx

  12. Lymphocytic variant • Male = females • FIP1L1-PDGFR ALPHA FUSION GENE MUTATION negative (-ive ) • Increase IGM;IgG ; • Thymus Chemokine (TARC) increased • Abnormal or clones of T Cells present • Good response to steroids

More Related