Eosinophilia has been documented in hemo- ... Eosinophilia from any other cause has also been reported to ... eosinophils and absolute eosinophil count was.
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Saudi Journal of Kidney Diseases and Transplantation
Letter to the Editor A Patient with Hemodialysis Intolerance and Hypereosinophilia To the Editor, Eosinophilia has been documented in hemodialysis patients1,2 as a manifestation of hypersensitivity to the dialysis equipment and procedure. Eosinophilia from any other cause has also been reported to cause life-threatening reactions in patients undergoing hemodialysis due to the release of interleukins and eosinophil peroxidase by degranulation from eosinophils. We report a patient who developed hemodialysis intolerance due to hypereosinophilia that responded dramatically to a short course of steroids. A 61-year-old male, long-standing type-2 diabetic and hypertensive, with end-stage renal disease secondary to diabetic nephropathy on maintenance thrice weekly hemodialysis since the last 20 months started developing acute onset of chills and rigors, acute anxiety, vomiting and unexplained abdominal pain about ½ – 1 h into the dialysis session. These episodes, which had not occurred earlier, had started from the previous one month and caused acute distress to the patient, necessitating requests for early termination of dialysis. The patient denied any complaints at home except for severe itching, which had started at approximately the same time. No new medications had been initiated in the preceding months and no history of documented allergies could be got from the patient. He denied any specific food allergies as well. Antiemetics and antihistaminics administered on dialysis failed to have any impact. These events were seen with unfailing regularity at every session on dialy-
sis and stopped only after discontinuing the dialysis. The dialyzer used was a 1.3 m2 polysulphone dialyser. The tubings and the dialyzer were changed, but this did not bring about any change. His blood investigations are as follows: Hb 9 g/dL, total WBC count 10,800/mm3, differential count revealed 24% eosinophils and absolute eosinophil count was high at 2600/mm3 (normal 40–440). The urea reduction rate on dialysis was 62% and the liver function tests, calcium and phosphorus were normal. Physical examination revealed xerotic, exfoliating skin all over the body, more on the extensor aspect of the arms and back. The oral cavity did not show any mucosal lesions. Examination of the cardiovascular, respiratory and gastrointestinal systems was normal. He was given a course of prednisone at 0.5 mg/kg for two weeks followed by a gradual taper over four weeks The absolute eosinophil count (AEC) reduced to 260/mm3 with treatment and adverse reactions subsided on dialysis. A similar benefit was seen with respect to pruritus. No definite cause for hypereosinophilia was detected in this patient. No recurrence has been seen at one month followup so far and the AEC remains
