Date: [DATE]
Patient: [Patient Name]
MRN: [Medical Record Number]
Reason for Visit:
Document the reason for this visit. This may be:
Initial evaluation for a newly identified eosinophilia.
Follow-up visit for a patient with known eosinophilia.
Visit to address a specific symptom or concern related to eosinophilia.
History of Present Illness:
For newly diagnosed eosinophilia:
Onset and duration of any symptoms suggestive of eosinophilic conditions (e.g., fatigue, skin rash, respiratory symptoms, gastrointestinal symptoms).
Travel history (some parasitic infections can cause eosinophilia).
Recent illnesses or medication use (certain medications can cause drug-induced eosinophilia).
For established eosinophilia:
Changes in symptoms or development of new symptoms.
Response to previous treatment modalities.
Adherence to current treatment plan.
Past Medical History:
Briefly document any relevant past medical conditions, surgeries, or allergies, especially:
Atopic diseases (e.g., asthma, eczema)
Autoimmune conditions (e.g., lupus)
Infections (history of parasitic infections)
Allergies (drug allergies)
Prior malignancies (some cancers can cause eosinophilia)
Social History:
Inquire about exposures that may increase risk of eosinophilia (e.g., occupational dust exposure, pet ownership).
Medications:
List all current medications, including:
Medications used to treat the eosinophilia (e.g., steroids)
Medications potentially contributing to eosinophilia
Allergies:
Document any known allergies, especially allergies to medications used to treat eosinophilia.
Family History:
Inquire about a family history of atopic diseases or eosinophilic disorders.
Physical Exam:
Vital Signs: Include temperature (if concerning for infection).
Skin Exam:
Look for signs suggestive of eosinophilic conditions (e.g., urticarial rash, eczema).
Assess for lymphadenopathy (swollen lymph nodes).
Other organ system exams may be pertinent depending on presenting symptoms.
Laboratory:
Complete blood count (CBC): Confirm eosinophilia (absolute eosinophil count > 1500/mcL).
Additional tests may be ordered based on suspicion of specific causes:
Peripheral blood smear: Evaluate the morphology of eosinophils.
Stool ova and parasites: Rule out parasitic infections.
Autoimmune serologies: Evaluate for autoimmune conditions.
Serum specific IgE levels: May be helpful in allergic eosinophilic conditions.
Bone marrow biopsy: Considered in some cases to identify the cause (e.g., hypereosinophilic syndrome).
Imaging:
Imaging studies are not routinely used for eosinophilia but may be indicated depending on suspected cause (e.g., chest X-ray for pulmonary involvement).
Assessment:
Eosinophilia: Document the absolute eosinophil count.
Suspected cause of eosinophilia: Based on clinical presentation, laboratory findings, and potential exposures.
Consider common causes such as:
Allergic conditions (e.g., drug allergy, atopic dermatitis)
Parasitic infections
Autoimmune conditions
Hypereosinophilic syndrome (HES) – a group of disorders with unknown cause and high eosinophil count
Drug-induced eosinophilia
Malignancy (less common)
Differential diagnosis: Depending on the presentation, consider other conditions that can cause similar symptoms.
Plan:
The treatment plan will depend on the identified cause of eosinophilia.
Possible treatment options include:
Identifying and addressing the underlying cause: Treating infections, stopping offending medications.
Corticosteroids: The mainstay of treatment for many eosinophilic conditions to reduce inflammation.
Other medications: Immunomodulatory drugs or targeted therapies may be used in specific cases.
Supportive care: Manage symptoms and prevent complications.
Discuss the prognosis and potential complications of eosinophilia and the planned treatment.
Follow-up:
The follow-up schedule will depend on the severity of eosinophilia and response to treatment.
Close monitoring of eosinophil count is necessary.
Repeat laboratory tests as needed to assess response to treatment.
Consider referral to a specialist (e.g., allergist, hematologist