875 Eosinophilia and Adrenal InsufficiencyC. C. Hassett, L. G. Wild; Tulane University, New Orleans,

LA.

RATIONALE: 60 y Caucasian woman referred for eosinophilia

evaluation.

METHODS: Patient was admitted to the hospital for osteomyelitis. She

has a history of COPD, heart failure and rheumatoid arthritis treated

with 10mg of prednisone daily (prior to admission). She was started on van-

comycin, rifampin and piperacillin-tazobactam for 19 days until she devel-

oped a red, scaly rash which was thought to be Red Man syndrome. The

vancomycin was discontinued and linezolid initiated. She had an elevated

eosinophil count of 882 (9% of 9,800 WBC) that gradually increased to

5,280 (32% of 16,500 WBC). Linezolid was continued and piperacillin-ta-

zobactam stopped and restarted with fluctuation in the eosinophil count but

never normalization. Physical exam was significant for a mild macuopap-

ular rash with areas of erythema that was resolving. Laboratory tests

included a negative HIV test, positive blood cultures for MRSA and ele-

vated WBC counts that decreased with antibiotics.

RESULTS: She had a random cortisol that was 6.2mcg/dL. After stimula-

tion with cosyntropin this only increased to 10.3 mcg/dL then 12.3 mcg/dL

which was an inadequate response. This was repeated and was again abnor-

mal. She was treated with 7.5mg prednisone and in 24 hours her eosino-

phils were 2% of a WBC count of 12,700 for an absolute eosinophil

count of 254.

CONCLUSIONS: The differential for eosinophilia is vast. Adrenal insuf-

ficiency can cause eosinophilia and must be considered in the differential

diagnosis, especially in a patient on chronic steroid therapy.

876 Reactive Eosinophilia to Invasive Candidiasis Responding toCaspofungin

G. Shanmugam, B. L. Buchmiller, D. A. Wierzbicki, M. T. de la Morena;

UT Southwestern, Dallas, TX.

RATIONALE: Peripheral eosinophilia can be caused by drugs, infection,

eosinophilia myalgia syndrome, or idiopathic hypereosinophilic syn-

drome. Significant peripheral eosinophilia due to candidiasis is rare. We

describe a case of a patient with an eosinophil count >28,000/mm3 associ-

ated with Candida parapsilosis infection.

METHODS: Case Report.

RESULTS: The patient is a 6 year old boy with prune belly syndrome and

renal failure on regular hemodialysis. On admission he presented with fe-

ver and projectile vomiting; absolute eosinophil count (AEC) was zero.

Due to previous bladder augmentation surgery, an exploratory laparotomy

was performed which revealed an intra-abdominal abscess. Cultures of the

abscess grew rare yeast and the patient was placed on liposomal amphoter-

icin B. AEC began to rise on post operative day 4 and reached a peak of

28,248/mm3 on post operative day 22. Possible etiologic agents for eosin-

ophilia, which included NSAIDS and methadone, were discontinued

with no change in eosinophilia. Stool ova and parasites were negative.

Coccidioides antibody titers were all negative. IgE levels were normal.

IL-5 level was elevated at 26 pg/mL. Three weeks later, the patient under-

went repeat laparotomy and intra-abdominal fluid culture grew Candida

parapsilosis. Caspofungin was added to his treatment regimen. Subsequent

decline in AEC was noted and was 1100/mm3 three weeks after treatment

with clinical improvement.

CONCLUSIONS: Marked reactive eosinophilia may occur secondary to

invasive candidiasis. Treating the underlying infection, in this case,

Candida parapsilosis, was temporally related to improvement of eosino-

philia.

Funding: University of Texas at Southwestern

877 Churg-Strauss Presenting as Pulmonary Embolism,Lymphadenopathy and Eosinophilia

T. Chacko, R. Frank, D. Ledford, R. F. Lockey; University of South Flor-

ida Collge of Medicine, Tampa, FL.

RATIONALE: This is a case of Churg-Strauss vasculitis without a history

of asthma presenting with pulmonary embolism, lymphadenopathy, and

eosinophilia.

METHODS: A 53-year-old male presented to the hospital with worsening

shortness of breath for two weeks and mediastinal lymphadenopathy. Two

days prior, he was discharged from another hospital where cardiac cathe-

rization was normal, CT demonstrated mediastinal lymphadenopathy

with no evidence of pulmonary embolism, and he was prescribed predni-

sone, 20 mg, po daily for possible lymphoma. His PMH, SH, FH, and

ROS were unremarkable and physical exam normal. Laboratory studies

were remarkable for WBC 16,700/mm3 (normal 4.2-10.3 mm3), 38%

eosinophils (normal 1-7%), and troponin I 6.88 ng/mL (normal 0.0-0.32

ng/mL).

RESULTS: CT angiogram revealed multiple small pulmonary emboli and

mediastinal lymphadenopathy. Laboratory studies revealed persistent leu-

kocytosis and eosinophilia while on prednisone, 40 mg, po daily (WBC

24.1/mm3, 54% eosinophils). ANA and ANCAs were negative. The patient

complained of headaches, and MRI/MRA of the brain revealed possible

vasculitis. Prednisone was increased to 40 mg po bid. Mediastinal lymph

node biopsy revealed eosinophilic granulomatous vasculitis involving

medium sized arteries (no evidence of malignancy), and cyclophospha-

mide,150 mg, po qd was prescribed. Two days later, the patient felt well

and had resolution of his shortness of breath, headache, and improvement

of eosinophilia (WBC 19.2/ mm3, 25% eosinophils).

CONCLUSIONS: Churg-Strauss vasculitis can present with lymphade-

nopathy, pulmonary embolism and persistent eosinophilia in the absence

of asthma and positive ANCAs.

Funding: Joy McCann Culverhouse and Mabel and Ellsworth Simmons

Endowments

878 Allergens Associated with Ocular and Nasal Symptoms: AnEpidemiologic Study

K. Singh, L. Bielory, E. Kavosh; UMDNJ, Newark, NJ.

RATIONALE: To determine potency of common allergens associated

with ocular and nasal allergic symptoms.

METHODS: The National Health and Nutrition Examination Survey III

database (NHANES) was evaluated to determine the relation between pos-

itive wheal reaction (WR) and report of allergy symptoms. The NHANES

questions used for screening were: ‘‘During the past 12 months, have you

had any episodes of watery, itchy eyes? During the past 12 months have you

had any episodes of stuffy, itchy, or runny nose? How many episodes in the

last 12 months have you had of either watery, itchy eyes or stuffy, itchy or

runny nose?’’ The data was stratified into three populations: allergic rhinitis

(AR), allergic conjunctivitis (AC) and those with both AC and AR

(AR1AC). WR data was extracted for White oak, Russian thistle, peren-

nial rye (PR), rye grass, Alternaria alternata, Bermuda grass (BG), short

ragweed (RW), cat, house dust mite (HDM) and German cockroach

(GC). The percentage of positive WR for each allergen was calculated

and compared across all three populations.

RESULTS: 3263 individuals had positive skin testing (AR 5 1034; AC 5

300; AR1AC 5 1929) with no overlap of patients. All three populations

had a 60% reactivity to outdoor allergens and 40% to indoor allergens.

For all populations, the most common outdoor allergens were PR (13.6-

16.4%) > RW (14.3-15%) > BG (9.5-10.8%). The most common indoor

allergens were GC (13.3-18%) > HDM (12.3-14.4%).

CONCLUSIONS: The most potent allergens are cockroach, dust mite,

perennial rye and ragweed for both ocular and nasal symptoms.

J ALLERGY CLIN IMMUNOL

VOLUME 119, NUMBER 1

Abstracts S223

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