Guest guest Posted January 18, 2006 Report Share Posted January 18, 2006 Hello All. I have been a follower - albeit a silent one - for a few years now. I was diagnosed with PSC accidently in January 2003 via ERCP. I was hospitalized at that time for a debilitating internal infection of unknown origin that kept me hospitalized for over a week. Since 2003, I have been watched closely, am on Urso, have yearly CT's and have had two ERCP's. Liver enzymes only slightly to moderately elevated. In April 2005 - I developed a strange rash throughout my body. I have since developed allergies to foods I've never had problems with before. In addition - my eosinophil level went up correlating with the rash to 10% (normal is less than 7). It has been and continues to be over 3 x's normal levels since April, 2005. A recent liver biopsy indicated inflammation - no sclerosis - yet specimens saturated with eosinophils. Any of this ring any bells with anybody? PS - Hematologist in Fall 2005 found no explanation for Eos. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 18, 2006 Report Share Posted January 18, 2006 Dear " rotingut " ; There have been some reports of eosinophilia and eosinophilic infiltration in the liver in PSC. Here are a couple of articles describing this: ___________________ J Gastroenterol. 1995 Aug;30(4):524-8. Primary sclerosing cholangitis with marked eosinophilic infiltration in the liver. Watanabe H, Ohira H, Kuroda M, Takagi T, Ishikawa H, Nishimaki T, Kasukawa R, Takahashi K. Department of Internal Medicine II, Fukushima Medical College, Japan. A 16-year-old boy was diagnosed as having primary sclerosing cholangitis (PSC), based on retrograde cholangiography showing mixed features of narrowing and dilatation of the common hepatic and intrahepatic bile ducts. However, periductal fibrosis was not observed in the needle biopsy liver specimen. The liver biopsy specimen obtained 11 years previously, at the onset of the disease had disclosed a marked infiltration of eosinophils in the portal tract with eosinophilic catinonic protein immunostaining, with marked eosinophilia (54%) being noted. In Japanese reports, eosinophilia of more than 7% was reported in 13 of 32 (40.6%) PSC patients. However, the early stage of PSC, with marked eosinophilia and eosinophilic infiltration in the liver, such as in the present case, has rarely been reported. The findings in this case suggest that eosinocytes are related to the pathogenesis of PSC. Publication Types: Case Reports PMID: 7550866 ___________________ Am J Gastroenterol. 1993 Oct;88(10):1764-9. Eosinophilic sclerosing cholangitis associated with hypereosinophilic syndrome. Grauer L, Padilla VM 3rd, Bouza L, Barkin JS. Division of Gastroenterology, University of Miami, School of Medicine/Mt. Sinai Medical Center, Miami Beach, Florida. We describe the case of a 41-yr-old man who presented with signs and symptoms of cholestasis including abdominal pain, jaundice, and fever, with peripheral eosinophilia of 10% and bone marrow eosinophilia. Liver biopsy revealed an eosinophilic infiltrate and an ERCP demonstrated bile duct changes, compatible with primary sclerosing cholangitis (PSC). After treatment with prednisone and ursodeoxycholic acid, the patient's liver profile tests returned to normal, the ERCP changes resolved, and all symptoms disappeared. A literature review has not shown any previous reports of reversible sclerosing cholangitis, secondary to eosinophilic infiltration. The purpose of this report is to describe eosinophilic cholangitis, an entity that mimics PSC in the context of the hypereosinophilic syndrome. Publication Types: Case Reports Review PMID: 8213721 ___________________ You might want to bring these to the attention of your doctors? Lee Bria and I have been discussing this privately ... she may have a few comments to add about her son's case? Best regards, Dave (father of (20); PSC 07/03; UC 08/03) > > In April 2005 - I developed a strange rash throughout my body. I > have since developed allergies to foods I've never had problems with before. In addition - my eosinophil level went up correlating with the rash to 10% (normal is less than 7). It has been and continues to be over 3 x's normal levels since April, 2005. > > A recent liver biopsy indicated inflammation - no sclerosis - yet > specimens saturated with eosinophils. > > Any of this ring any bells with anybody? > > PS - Hematologist in Fall 2005 found no explanation for Eos. > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 19, 2006 Report Share Posted January 19, 2006 I read those cases, too. My problem is - I have not had elevated eosinophils until 2005. Diagnosis was made in 2003 with lab results in 2003 and 2004 noting normal eosinophil levels. ????? According to MGH - this is extremely rare. In addition - the pathologist was completely thrown by the biopsy results having seen PSC biopsy specimens many times before. > > > > In April 2005 - I developed a strange rash throughout my body. I > > have since developed allergies to foods I've never had problems > with before. In addition - my eosinophil level went up correlating > with the rash to 10% (normal is less than 7). It has been and > continues to be over 3 x's normal levels since April, 2005. > > > > A recent liver biopsy indicated inflammation - no sclerosis - yet > > specimens saturated with eosinophils. > > > > Any of this ring any bells with anybody? > > > > PS - Hematologist in Fall 2005 found no explanation for Eos. > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 19, 2006 Report Share Posted January 19, 2006 Have they ruled out other causes of eosinophilia, such as drug-induced eosinophilia: http://www.postgradmed.com/issues/1999/03_99/brigden.htm R. > > I read those cases, too. My problem is - I have not had elevated > eosinophils until 2005. Diagnosis was made in 2003 with lab results > in 2003 and 2004 noting normal eosinophil levels. > > ????? > > According to MGH - this is extremely rare. In addition - the > pathologist was completely thrown by the biopsy results having seen > PSC biopsy specimens many times before. > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 19, 2006 Report Share Posted January 19, 2006 I am currently only on Urso - and have been since 2003. So - drug- induced eosinophilia seems unlikely. A hemotologist late last year suggested that the elevation is too great to be related to allergic reactions of any kind. Gastro in Boston is considering the next step. I have read literature that suggests at least 40% of PSC patients have some elevations in eo's - I am looking for confirmation of this fact. The lack of responses is suggesting contrary to the data. Thank you for responding. Some times merely talking to people about it alleviates frustration levels for me. > > > > I read those cases, too. My problem is - I have not had elevated > > eosinophils until 2005. Diagnosis was made in 2003 with lab results > > in 2003 and 2004 noting normal eosinophil levels. > > > > ????? > > > > According to MGH - this is extremely rare. In addition - the > > pathologist was completely thrown by the biopsy results having seen > > PSC biopsy specimens many times before. > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 19, 2006 Report Share Posted January 19, 2006 Is it possible the Eosinophils is caused by UC, like this lady has? Postgrad Med J 1977 Feb;53(616):105-8. Ulcerative colitis with chronic liver disease, eosinophilia and auto-immune thyroid disease. Kane SP. A patient with chronic mild ulcerative colitis is described. Her illness was characterized by fluctuating blood eosinophilia, chronic persistent hepatitis and hypersensitivity to sulphasalazine. She subsequently developed auto-immune thyroid disease. The inter-relationships of these various disorders are discussed. PMID: 876921 [PubMed - indexed for MEDLINE] Here is a good article on Eosinophils, maybe it will help: http://www.netdoctor.co.uk/diseases/facts/eosinophilia.htm Barb in Texas - Together in the Fight, Whatever it Takes! Son (Ken) 31 - UC 91 & PSC 99 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 19, 2006 Report Share Posted January 19, 2006 Thanks Barb, I read this and scared myself. As far as being from the UC, then Bill's eos% should go down now that he has no colon and that is not the case.I didn't like the part about the eos% being up because of liver damage, cirrhosis.We have not had any biopsies yet and now this concerns me.I hope that Bill's are raised because of his allergies.Jeesh, always something new to add to the worry list.LeeIs it possible the Eosinophils is caused by UC, like this lady has Ulcerative colitis with chronic liver disease, eosinophilia and auto-immune thyroid disease. Kane SP.Here is a good article on Eosinophils, maybe it will help:http://www.netdoctor.co.uk/diseases/facts/eosinophilia.htm Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 20, 2006 Report Share Posted January 20, 2006 Okay, now you got my attention on this Eosinophils topic. I have always just overlooked that section of the bloodwork out of ignorance. I never knew what it meant and I always zero in on the liver functions. Now that I have looked at current and past labs...Todd has always had elevated eosinophils. But what is considered abnormally high? And most of all...what does all this mean? Is this something that is pretty common amongst most PSC/IBD patients? I must say we never stop learning here in this group. Together in the fight, Whatever it takes! Joanne (mom of Todd, psc 12/01, crohns 1/02, tx twice 12/03, recurrent psc 12/05 and living life to the fullest in 06 and liking his classes this semester) P.S. I am looking forward to meeting many of you at the PSC Conference in April!!! Quote Link to comment Share on other sites More sharing options...
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