Eosinophilic Ascites: A Rare Diagnosis With an Even Rarer Etiology.

Eosinophilic ascites (EA) is a rare and often challenging clinical manifestation of eosinophilic gastroenteritis (EGE), a condition characterized by eosinophilic infiltration in various layers of the gastrointestinal tract. EA specifically involves the abnormal accumulation of eosinophils in the peritoneal cavity, which can lead to significant abdominal distension and discomfort. EGE is an inflammatory disorder that can affect the mucosal, muscular, or serosal layers of the gastrointestinal tract, primarily resulting from a combination of genetic predisposition, environmental triggers, and immune responses. This case report discusses a 39-year-old male who presented with persistent abdominal distension, significant weight loss, vomiting, and chronic diarrhea. Clinical evaluation revealed marked eosinophilia and EA, prompting a series of diagnostic tests to differentiate it from other potential causes such as parasitic infections and malignancies. Imaging studies indicated moderate ascites and intestinal wall thickening. The patient was diagnosed with eosinophilic enteritis, and treatment with corticosteroids led to substantial clinical improvement. This case highlights the diagnostic challenges and management strategies associated with both EA and EGE, emphasizing the importance of recognizing these rare manifestations of eosinophilic gastrointestinal disorders.

Pityriasis rubra pilaris with eosinophilia in a young patient: a case report.

Introduction and importance: Pityriasis rubra pilaris is a rare inflammatory papulosquamous disorder which manifests in six clinical subtypes affecting both pediatric and adult populations. Presentation of case: A 14-year-old female presented with multiple itchy scaly lesions on her hands and legs which began as vesicles 9 days after birth. Histopathological examination confirmed the diagnosis of pityriasis rubra pilaris. Further investigations revealed significant peripheral and tissue eosinophilia. The patient was treated with oral isotretinoin, which resulted in the resolution of the lesions. Case discussion: It is a rare inflammatory papulosquamous disorder characterized by palmoplantar keratoderma and follicular papules coalescing into distinct plaques characterized by a reddish-orange hue and nonadherent flaking scales. The patients with tissue and/or peripheral eosinophilia are usually older at presentation and more likely to have multisite disease. Our patient, in contrast, is a young female which makes this case noteworthy. Conclusion: This unusual finding of eosinophilia in a young patient underscores the necessity for further research and evaluation to enhance understanding of the pathophysiology of pityriasis rubra pilaris.

Eosinophilia and Adverse Effects of Dupilumab for Respiratory Indications: A Real-World Setting.

BACKGROUND: Dupilumab has been used with significant benefit in the treatment of asthma and chronic rhinosinusitis with nasal polyps (CRSwNP). Phase 3 clinical trials have demonstrated transient eosinophilia and rare eosinophil-related and other adverse effects. OBJECTIVE: To characterize dupilumab-associated eosinophilia (absolute eosinophil count [AEC] ≥ 1.5 x 103/µL within 36 weeks of dupilumab initiation) and adverse effects associated in real-world patients with asthma and CRSwNP in the United States. METHODS: Retrospective chart review of 251 patients on dupilumab for asthma and/or CRSwNP seen at a single institution. RESULTS: Among the 142 patients who had AECs checked before and after treatment, 16 (11.3%) patients had post-treatment eosinophilia, including 11 (7.7%) patients who had new eosinophilia upon dupilumab initiation. Thirteen patients with post-treatment eosinophilia remained on dupilumab, 10 of whom had resolution of eosinophilia. Eosinophil-related adverse effects were rare and cases of eosinophilic granulomatous polyangiitis (EGPA) were limited to 1 patient with eosinophilia and 1 patient with normal eosinophil levels on systemic steroids. Other adverse effects included arthralgias (13/251, 5.2%), rash (8/251, 3.2%), and conjunctivitis (7/251, 2.8%). All patients with pre-treatment eosinophilia and the majority of patients with post-treatment eosinophilia received significant treatment benefit for their respiratory disease with dupilumab. CONCLUSION: While dupilumab-associated eosinophilia is seen in a subset of patients, persistent eosinophilia or eosinophil-related adverse effects are rare. Furthermore, treatment benefit on dupilumab despite eosinophilia supports its continued use in both asthma and CRSwNP.

Demystifying drug reaction with eosinophilia and systemic symptoms (DRESS): a review of the literature and guidelines for management.

Drug reaction with eosinophilia and systemic symptoms (DRESS) is a severe, adverse drug reaction that is notoriously complex in both its presentation and treatment. Although early diagnosis and cessation of the causative agent are universally accepted as the initial interventions for DRESS, the subsequent management lacks a standardized approach. Historically, systemic steroids have been used as first-line treatment, but there is debate about the optimal dosing and route of administration, and evidence persists on the long-term complications associated with steroid use. Novel treatment approaches with targeted therapy, cyclosporine, intravenous immunoglobulin, and plasmapheresis have been gaining interest as alternative mono- and adjuvant therapies, but their use has yet to be supported by clinical trials. This narrative review provides a summary of the current knowledge of DRESS, with a focus on clinical management. The various mono- and adjuvant therapy options are discussed, with literature-supported suggestions for their optimal use in clinical practice. The risks for relapses, viral reactivation, and long-term complications are also considered. The PubMed and Medline databases were searched for articles on DRESS, published between January 1, 2008, and May 1, 2023. 334 articles met the inclusion criteria. Based on the literature, a DRESS management tool with step-by-step guidance is provided. Further suggestions for management are woven throughout this review, giving clinicians a toolbelt of resources with which to approach diagnosis, treatment, and follow-up.

A multicentre comparative cohort study of severe maculopapular exanthema and drug reaction with eosinophilia and systematic symptoms.

CLINICAL IMPLICATIONS: In a prospective cohort of antibiotic-associated delayed hypersensitivity reactions, key clinical characteristics and diagnostic discrepancies (in vivo and ex vivo) were noted between DRESS (RegiSCAR ≥4) patients and those with lower RegiSCAR scores (RegiSCAR 2-3) patients.

A Systematic Review and Metaanalysis to Examine the Utility of Histological Parameters Such as Mucosal Basal Plasmacytosis and Eosinophilia for Distinguishing Inflammatory Bowel Disease and Non-IBD-Type Colitis.

Background and aim: Basic differentiation between an inflammatory bowel disease (IBD)-type colitis and a non-IBD type of colitis is the essential histological pre-requisite before further subclassifications are made. The combination of mucosal prominent eosinophilic cell infiltrate along with basal plasmacytosis is supposed to be a useful histological feature that can differentiate between IBD-type and non-IBD-type colitis. Hence, this systematic review and metaanalysis aimed to assess the reliability of mucosal basal plasmacytosis and eosinophilia for histological differentiation of IBD-type versus non-IBD-type colitis. Methods: We searched the PROSPERO, PubMed, Embase, and Scopus from January 1, 2000 to July 30, 2022 for all types of studies (prospective, cross-sectional, or retrospective studies) having histological features (including mucosal basal plasmacytosis, eosinophilia, and neutrophilic infiltration) in IBD and/or non-IBD colitis cases. Two reviewers extracted data, which were aggregated using random-effects models. Results: The 59 selected articles were evaluated for the predecided parameters. Both basal plasmacytosis and lamina propria plasmacytosis did not show any significant correlation between IBD-type and non-IBD-type colitis. The proportions for basal plasmacytosis with 95% CI were 0.50 (0.19-0.82) in IBD-type colitis and 0.46 (0.40-0.52) in non-IBD-type colitis, with a P value of .79. The proportion of lamina propria plasmacytosis with 95% CI was 0.67 (0.42-0.92) in IBD and 0.60 (0.35-0.85) in non-IBD-type colitis, with a P value being .7. Conclusions: This systematic review documented the dearth of published data on key histological features such as basal plasmacytosis and mucosal eosinophilia which are believed to differentiate between IBD-type and non-IBD-type colitis.

Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) Syndrome with Multiple Drugs (Leflunomide and Cefuroxime): A Case Report.

BACKGROUND: Adverse Drug Reactions (ADRs) are unexpected reactions to a medicine administered in the correct manner and at the proper dosage. Drug Rash with Eosinophilia and Systemic Symptoms syndrome (DRESS syndrome) is a Severe Cutaneous Adverse Reaction (SCAR) type of ADR with complicated clinical features involving several organ systems of the body; frequently involved organs are the liver, kidney, lungs, and other organs. Prompt recognition and correct diagnosis, followed by withdrawal of the causative agent, can promote appropriate treatment, accelerate recovery, and reduce the related morbidity and mortality. CASE PRESENTATION: We have, herein, presented a case of a 42-year-old female with a history of leflunomide intake for plantar fasciitis. The patient subsequently developed fever, gastrointestinal tract disturbance, facial edema, liver injury, skin rash, hematologic abnormalities (eosinophilia), hepatosplenomegaly, and lymph node enlargement. The probability of leflunomide-induced DRESS syndrome was rated as "definite", with seven scores graded by RegiSCAR. The suspected causative agent was withdrawn, and the patient was managed symptomatically. Following her management and discharge, she again encountered similar complaints after administration of the cefuroxime tablet. The causality assessment of the reactions was done using the WHO-UMC scale and Naranjo's assessment scale, and a "probable" reaction was found for both drugs. CONCLUSION: The presented case contributes to the existing global literature regarding exceptional clinical presentations. Leflunomide and cefuroxime drugs have the potential to cause DRESS syndrome. Thus, they should be handled cautiously, and if such a reaction occurs, it should be reported to the responsible authorities.

A case report of minimal change disease associated with Kimura disease complicated by optic neuritis.

Kimura disease (KD) is a rare chronic inflammatory disease that typically presents with soft subcutaneous granulomas in the head and neck regions characterized by elevated blood eosinophils and immunoglobulin E (IgE) level, whose aetiology remains poorly elucidated. Minimal change disease (MCD) has been reported as one of the renal manifestations that KD can present with, indicating that they may share a common pathology. Herein we describe a case of recurrent MCD associated with KD. During a follow-up period of 15 years, MCD recurred three times with increased disease activity of KD as reflected by flares of skin lesions and elevated peripheral eosinophils, and responded well to increased doses of prednisolone and cyclosporin. Notably, visual field defects in his right monocular vision appeared at the time of third recurrence of MCD, leading to the diagnosis of optic neuritis (ON). Optic nerve involvement associated with KD is extremely rare, and this case is noteworthy in that inflammation in the optic nerve was observed at the time of MCD recurrence with increased disease activity of KD, suggesting the existence of a common pathology between KD, MCD, and ON. In patients with KD, an imbalance of T helper (Th) cells with Th2 cells predominating over Th1 cells is observed, which results in hyperIgEemia and eosinophilia. This Th2-predominant immunological status in KD considered to predispose to MCD may also predispose to ON. MCD with a background of Th2-predominant immune state may require attention to the possibility of complication of ON.

Possible Association of CD3+CD4-CD8- Phenotype of T-Cell Lymphoma with Peripheral Blood Eosinophilia.

INTRODUCTION: Because the prognosis of patients with peripheral T-cell lymphoma is poor compared to that of patients with B-cell lymphoma, we want to avoid further organ damage by eosinophilia. Moreover, in patients with some types of lymphoma, blood eosinophilia is implicated in a worse prognosis. To study the risk factors of eosinophilia, the association between lymphoma type, immunophenotypic features, and peripheral blood eosinophil counts were examined in the patients with mature T-cell lymphoma. METHODS: We retrospectively examined 28 patients with mature T-cell lymphoma who were admitted to our hospital and whose immunophenotypic features were confirmed using flow cytometric, immunohistochemical analysis, or both between December 2012 and November 2023. RESULTS: We report a possible association between peripheral eosinophilia and peripheral T-cell lymphoma - not otherwise specified and CD3+CD4-D8- (double-negative) phenotypes. Mild eosinophilia was observed in various types, but moderate and severe eosinophilia were observed in patients with peripheral T-cell lymphoma - not otherwise specified. Double-negative phenotype was rarely observed; however, all patients with double-negative phenotype exhibited peripheral blood eosinophilia. In addition, four of the five cases of the double-negative type were peripheral T-cell lymphoma - not otherwise specified. CONCLUSION: Here, we retrospectively examined patients with peripheral T-cell lymphoma whose immunophenotypic features were confirmed and report a possible association between peripheral eosinophilia and peripheral T-cell lymphoma - not otherwise specified and CD3+CD4-CD8- (double-negative) phenotypes. In addition, clinicians should be aware of the possible risk that patients with lymphocytic hypereosinophilic syndrome of the double-negative phenotype may develop peripheral T-cell lymphoma.

Peripheral Inflammation Featuring Eosinophilia or Neutrophilia Is Associated with the Survival and Infiltration of Eosinophils within the Tumor among Various Histological Subgroups of Patients with NSCLC.

Immune activation status determines non-small cell lung cancer (NSCLC) prognosis, with reported positive/negative associations for T helper type 2 (TH2) responses, including allergen-specific IgE and eosinophils. Our study seeks to explore the potential impact of these comorbid immune responses on the survival rates of patients with NSCLC. Our retrospective study used data from the Data Warehouse of the German Center for Lung Research (DZL) and Lung Biobank at Thoraxklinik Heidelberg. We estimated the association of blood eosinophilia and neutrophilia on survival rates in an inflammatory cohort of 3143 patients with NSCLC. We also tested sensitization to food and inhalants and high-sensitivity C-reactive protein (hs-CRP) in a comorbidity cohort of 212 patients with NSCLC. Finally, we estimated the infiltration of immune-relevant cells including eosinophils, T-cells, and mast cells in a tissue inflammatory sub-cohort of 60 patients with NSCLC. Sensitization to at least one food or inhalant (sIgE) was higher in patients with adenocarcinoma (adeno-LC) than the non-adenocarcinoma (non-adeno-LC). Furthermore, hs-CRP was higher in non-adeno-LC compared with adeno-LC. Peripheral inflammation, particularly eosinophilia and neutrophilia, was associated with poor survival outcomes in NSCLC with a clear difference between histological subgroups. Finally, blood eosinophilia was paralleled by significant eosinophil infiltration into the peritumoral tissue in the lung. This study provides novel perspectives on the crucial role of peripheral inflammation, featuring eosinophilia and neutrophilia, with overall survival, underscoring distinctions between NSCLC subgroups (adeno-LC vs. non-adeno-LC). Peripheral eosinophilia enhances eosinophil infiltration into tumors. This sheds light on the complex interplay between inflammation, eosinophil infiltration, and NSCLC prognosis among various histological subtypes. Further studies are required to underscore the role of eosinophils in NSCLC among different histological subgroups and their role in shaping the tumor microenvironment.

Invasive Mediastinal Aspergillosis in an 18-Year-Old Immunocompetent Female Leading to Stroke.

We present a case of invasive pulmonary aspergillosis in an immunocompetent young female. An 18-year-old female presented with symptoms of a left-sided middle cerebral artery (MCA) stroke with right arm weakness and aphasia. Computed tomography (CT) brain confirmed the diagnosis of stroke. Further history revealed that the patient had been experiencing low-grade fevers with occasional shortness of breath for the past year. The blood work had eosinophilia at that time for which she was given mebendazole but saw little improvement. Chest X-rays showed upper lobe consolidation for which a tuberculosis (TB) workup was also done, which also came out negative. At the current presentation, she underwent further workup with echocardiography and eventual ultrasound-guided mediastinal biopsy that ultimately led to the correct diagnosis of aspergillosis. However, sadly, it was already too late for the patient who passed away one day after the commencement of the amphotericin B therapy. This paper hopes to decrease the threshold of clinical suspicion for invasive aspergillosis (IA) regardless of the immunity status of the patient, especially if they are presenting with an unrelenting mediastinal or pulmonary symptom complex in the setting of eosinophilia.

A new human opisthorchiasis outbreak in central Italy: a never-ending story.

PURPOSE: Opisthorchis felineus is a trematode causing a foodborne infection transmitted by raw freshwater fish belonging to Cyprinidae family. Human outbreaks in Italy dated back to 2003-2011 and involved lakes of Central Italy. The aim of this study is to report epidemiological and clinical characteristics of the human opisthorchiasis outbreak occurred in Central Italy in 2022 comparing it with previous events. METHODS: We report cases diagnosed from June to December 2022 in Perugia hospital thanks to serological and molecular tests and direct examination of feces. RESULTS: Sixty-seven individuals were traced back by epidemiological investigation. Forty-seven received a diagnosis of opisthorchiasis, of which 45 were confirmed cases and two were considered as probable cases. These 47 individuals attended a Trasimeno lakeshore restaurant in May 2022. All but 20 presented symptoms, mostly fever. Sixteen (15 confirmed and 1 probable) cases required hospitalization. Feces examination revealed Opisthorchis spp. eggs in 35/45 (78%) confirmed cases. Thirty individuals underwent to serology and molecular stool test: 5 (16.7%) results positive to the former, 1 (3.3%) to the latter while 4 (13.3%) to both. Laboratory tests, available in 28 patients, showed eosinophilia in 82.1%, increase of alanine aminotransferase, gamma-glutamyl transferase and alkaline phosphatase in 64.3%, 75% and 67.9%, respectively. Because of pharmacy shortage of praziquantel, 22 patients were treated with albendazole, of which 13 failed clearing the parasite. CONCLUSION: Opisthorchiasis still represents a challenging diagnosis, in particular for asymptomatic patients. Albendazole may lead to treatment failure. Control measures in known endemic areas should be implemented. TRIAL REGISTRATION: number 27,498/23/ON, approved by Ethical Committee of Umbrian Region in 09.13.2023.

Three cases of relapsed eosinophilic sinusitis without eosinophilia during mepolizumab maintenance therapy for eosinophilic granulomatosis with polyangiitis.

We present three cases of eosinophilic granulomatosis with polyangiitis (EGPA) where patients experienced relapse of eosinophilic sinusitis without peripheral eosinophilia while on remission maintenance therapy with mepolizumab (MPZ), an anti-interleukin (IL)-5 monoclonal antibody. Despite the initial control of symptoms with high-dose prednisolone (PSL) and MPZ, patients experienced a relapse of nasal obstruction and eosinophilic infiltration in nasal mucosal biopsies. Notably, relapses occurred despite normal peripheral eosinophil counts, indicating the localized nature of eosinophilic inflammation. While IL-5 inhibitors effectively reduce peripheral blood eosinophils, eosinophilic sinusitis may persist due to local factors such as IL-4-mediated inflammation. IL-4 has been implicated in promoting eosinophil migration into nasal tissues, suggesting that IL-5 inhibitors alone may not sufficiently suppress eosinophilic infiltration in such cases. These findings highlight the importance of considering the possibility of eosinophilic sinusitis relapse in EGPA patients treated with IL-5 inhibitors and reduced glucocorticoid doses. Further research is warranted to elucidate the mechanisms underlying local eosinophilic inflammation and optimize treatment strategies for EGPA patients.

Delayed drug hypersensitivity reactions: How p-i transforms pharmacology into immunology.

Delayed drug hypersensitivity reactions (dDHRs) are iatrogenic diseases, which are mostly due to non-covalent interactions of a drug with the immune receptors HLA and/or TCR causing T-cell activation. This is also known as pharmacological interaction with immune receptors or p-i. P-i activation differs from classical antigen-driven immune reactions: a) drug binding induces structural changes in TCR-HLA proteins which make them look like allo-like TCR-HLA-complexes, able to elicit allo-like stimulations of T cells with cytotoxicity and IFNγ production, notably without the involvement of innate immunity; b) drug binding to TCR and/or HLA can increase the affinity of TCR-HLA interactions, which may affect signaling and IL-5 production by CD4+ T cells, and thus contribute to eosinophilia commonly found in dDHRs or induce oligoclonal T cell expansions; c) Both, antigen and p-i stimulations can induce eosinophil- or neutrophil-rich inflammations; but these stimulations should be distinguished as their underlying mechanism and development differ; and d) p-i stimulation can - like graft versus host reactions - result in long-lasting T-cell activations, which can lead to viremia, occasional autoimmunity, or a new syndrome characterized by multiple drug hypersensitivity (MDH). In summary, dDHRs are not allergic reactions but represent peculiar T-cell activations, similar to allo-like stimulations. Understanding and considering the p-i mechanism is needed for preventive measures and optimal treatments of dDHR. In addition, it may help to understand TCR signaling, alloreactivity, and may even open a new way of specific immune stimulations.

Concurrent Eosinophilia Increases the Prevalence of Nail Abnormalities and Severity of Hair Loss in Patients With Alopecia Areata.

Background: The potential link between alopecia areata (AA) and eosinophilia is unclear, as well as its clinical manifestations in these patients' subsets. Methods: This is a monocentric retrospective observational study in which clinical and laboratory data were summarized and evaluated the AA subset with concurrent eosinophilia. Results: In a sample of 205 AA patients, 38 (18.5%) were classified as AA with eosinophilia. Interestingly, this subset of patients had a statistically higher prevalence of atopia and nail abnormalities (p < 0.05) than AA without eosinophilia. AA patients with eosinophilia had a 3.70 higher odds of more severe hair loss versus age- and gender-matched AA without eosinophilia. Conclusions: AA patients with eosinophilia had distinctive clinical and laboratory characteristics, so future studies may potentially explore the use of IL-5 inhibitors.

Postmarketing Analysis of Eosinophilic Adverse Reactions in the use of Biologic Therapies for Type 2 Inflammatory Conditions.

BACKGROUND: Temporary eosinophilia is a potential adverse reaction of monoclonal antibody therapies in the treatment of a variety of type 2 inflammatory conditions, including asthma and chronic rhinosinusitis with nasal polyposis (CRSwNP). The pathophysiology, epidemiology, and clinical significance of eosinophilia and eosinophilic adverse reactions following the initiation of biologic therapy are unclear. OBJECTIVES: To describe the postmarketing, eosinophilic adverse reactions with clinical significance in patients treated with the 3 biologic therapies approved by the U.S. Food and Drug Administration (FDA) for CRSwNP: dupilumab, omalizumab, and mepolizumab. METHODS: The FDA Adverse Event Reporting System (FAERS) Public Dashboard was searched for eosinophilic adverse reactions related to dupilumab, omalizumab, and mepolizumab treatments from November 2004 to December 2022. Data regarding each of the eosinophilic adverse reactions were extracted and analyzed. RESULTS: A total of 218, 270, and 134 reports of eosinophilic adverse reactions were reported among patients who were treated with dupilumab, omalizumab, and mepolizumab, respectively. The most common eosinophilic adverse reaction was eosinophilic granulomatosis with polyangiitis (338 patients), followed by eosinophilic respiratory tract reactions (158 patients). The most common indication for biological treatment among the reaction groups was asthma. CONCLUSIONS: Eosinophilic adverse reactions are rare but consequential complications of biological treatment. They are more common among patients treated for asthma and chronic rhinosinusitis with nasal polyposis. Measuring and monitoring blood eosinophil levels may be appropriate in specific clinical instances when patients are started on different biologic therapies for type 2 inflammatory conditions.

Clinical and laboratory characteristics of Toxocara canis infection among children in Ho Chi Minh City, Vietnam.

BACKGROUND: This study determines the clinical and paraclinical characteristics of children with Toxocara canis infection and serum eosinophil cut-off values for predicting toxocariasis in the group displaying symptoms of itching, urticaria and erythema. METHODS: A cross-sectional study was conducted during March and April 2023 with a sample size of 986 children aged 3-15 y. RESULTS: In total, 140 (14.2%) of the 986 participants had anti-T canis antibodies. The most frequently experienced symptoms in this group were itching (10.1%), abdominal pain (8.2%) and urticaria (3.3%). The rate of IgE increased (37%), and the rates of mild and high eosinophilia were 38% and 2.2%, respectively. There were significant differences in IgE concentration and eosinophil count, and for both IgE concentration and eosinophil count between the two groups with and without toxocariasis. The optimal threshold for eosinophil to predict toxocariasis was 0.38 K/µL, with itching, urticaria and erythema resulting in a sensitivity of 61.5%, a specificity of 82.1% and a receiver operating characteristic curve (area under the curve) of 0.71. CONCLUSIONS: This study confirmed a positive association between IgE concentration, eosinophil count and positive serology for T. canis. A general blood count, including eosinophils, is a simple test that can be performed in hospitals. Clinicians should target and screen for T.oxocara canis infection when children display clinical symptoms of itching, urticaria, erythema and eosinophilia. CLINICAL TRIAL REGISTRATION NUMBER: NCT05208333.

Eosinophilic reactive airways disease after immune checkpoint inhibitor treatment.

Immune checkpoint inhibitors (ICI) are increasingly utilized as first-line treatment for many solid tumour malignancies. One downside of ICI therapy is autoimmune-mediated organ inflammation, or immune-related adverse events (irAE). ICI-related pneumonitis, or non-infectious inflammation of the lung, is a well-described irAE. While guidelines surrounding ICI-related pneumonitis are well established, other ICI-related pulmonary toxicities, including reactive airways disease, are rarely described in the literature. Here, we present a series of patients without pre-existing COPD or asthma who developed reactive airways disease with peripheral eosinophilia after ICI therapy and without radiographic evidence of pneumonitis. The patients were treated with typical therapies for reactive airways disease, including- inhaled steroids, bronchodilators, systemic steroids, and in one instance, dupilumab. All experienced symptomatic improvement with these therapies, enabling some of the patients to continue receiving ICI therapy.

Successful Treatment of Angiolymphoid Hyperplasia with Eosinophilia Associated with Scalp Demodicosis Using Cryotherapy and Topical Metronidazole.

Angiolymphoid hyperplasia with eosinophilia (ALHE) is a rare, benign, vasoproliferative tumour. We report a 25-year-old female patient who reported in 2021 to a dermatology clinic in Rustaq, Oman, with multiple, grouped, erythematous dome-shaped papules and nodules of 6 months duration on the left temporo-occipital region. Biopsy findings were consistent with a diagnosis of ALHE with evidence of Demodex mite infestation in the sebaceous ducts. The patient demonstrated significant improvement following 7 weeks of treatment with multiple cryotherapy sessions and topical application of metronidazole gel. This case suggests that scalp demodicosis may represent a novel trigger for the development of ALHE.