Blood eosinophiliaEosinophilsCauses of eosinophiliaInfiltratesHypereosinophiliaSystemicEtiologyGranulomatosis with PolyangiitisAsthmaEosinophil countInfiltrationMyeloidPeripheral and tissue eosinophiliaAbsence of peripheral eosinophiliaSymptomsDiagnosisDisordersAbnormalitiesManifestationsAcuteIdiopathic eosinophiliaCorticosteroidsPDGFRAInflammatoryIHESOrganPatientsInvolvementReactive eosinophiliaOrgansClonalPersistentDrug-inducedChronicBiopsyCutaneousPrimaryVasculitis
Blood eosinophilia11
- If eosinophil levels are high in the blood, it is called blood eosinophilia. (mayoclinic.org)
- Blood eosinophilia can be found with a blood test such as a complete blood count. (mayoclinic.org)
- The detailed workup demonstrated blood eosinophilia, and the colonic biopsies revealed extensive eosinophilic infiltration. (karger.com)
- Idiopathic hypereosinophilic syndrome (IHES) is a rare disease characterized by peripheral blood eosinophilia and eosinophilic infiltration of multiple organs, including the nervous system. (koreamed.org)
- Hypereosinophilic syndrome (HES) constitutes a rare and heterogeneous group of disorders, defined as persistent and marked blood eosinophilia and/or tissue eosinophilia associated with a wide range of clinical manifestations reflecting eosinophil-induced tissue/organ damage. (orpha.net)
- In healthy individuals, eosinophilic granulocytes (eosinophils) constitute less than five percent of all white blood cells [ 1 ], and in clinical practice blood eosinophilia is defined as an eosinophil count ≥ 0.5x10 9 /l. (oncotarget.com)
- is a condition characterized by peripheral blood eosinophilia with manifestations of organ system involvement or dysfunction directly related to eosinophilia in patients who do not have parasitic, allergic, a clonal disorder of hematopoiesis, or other causes of eosinophilia. (msdmanuals.com)
- Which of the following is not a likely differential diagnosis for chest radiograph infiltrates and blood eosinophilia? (ersjournals.com)
- The other differential diagnoses can all present with peripheral blood eosinophilia and radiographic changes. (ersjournals.com)
- a syndrome of fleeting pulmonary findings and peripheral blood eosinophilia, is another eosinophilic pulmonary disease. (merckmanuals.com)
- Pulmonary opacities on chest imaging associated with blood eosinophilia are sometimes called PIE (pulmonary infiltrates with eosinophilia) syndrome. (merckmanuals.com)
Eosinophils13
- 3.?Dialogue Hypereosinophilic symptoms (HES) was redefined this year 2010 as a lot more than 1500/mm3 eosinophils with out a discernible extra trigger (eg, HIV disease, worm or parasite infection, allergic illnesses, medication allergies, and nonhematologic malignancies). (rawveronica.com)
- Eosinophilia (e-o-sin-o-FILL-e-uh) is the presence of too many eosinophils in the body. (mayoclinic.org)
- If you have tissue eosinophilia, the level of eosinophils in your blood is not always high. (mayoclinic.org)
- Over 500 eosinophils per microliter of blood is thought to be eosinophilia in adults. (mayoclinic.org)
- GM-CSF and IL-3 have been shown to be produced by eosinophils, and GM-CSF production was demonstrated in the T-cell clones from patients with hypereosinophilic syndrome. (medscape.com)
- Eosinophils in hypereosinophilic syndrome infiltrate multiple organs where they inflict tissue damage through the release of granule proteins, including eosinophil peroxidase, major basic protein, eosinophil-derived neurotoxin, and eosinophil cationic protein. (medscape.com)
- Jani K, Kempski HM, Reeves RB: A case of myelodysplasia with eosinophilia having a translocation t(5;12)(q31;q13) restricted to myeloid cells but not involving eosinophils. (karger.com)
- Eosinophilic colitis and hypereosinophilic syndrome with colic involvement are rare diagnosis that are characterized by wide-ranging gastrointestinal symptoms and idiopathic infiltration of eosinophils in the colon. (karger.com)
- We analyzed purified eosinophils from patients with IHES by next-generation whole-exome sequencing and compared DNA methylation profiles from reactive eosinophilic conditions to known clonal and suspected clonal eosinophilia. (oncotarget.com)
- Eosinophilia has features of an immune response: an agent such as Trichinella spiralis invokes a primary response with relatively low levels of eosinophils, whereas repeated exposures result in an augmented or secondary eosinophilic response. (msdmanuals.com)
- Routine blood tests revealed an eosinophilia of 9×10 9 eosinophils per L and a C-reactive protein concentration of 106 mg⋅L −1 . (ersjournals.com)
- On the other hand, the increase in number of eosinophils and the activation of these cells, both of which are related to elevated IL5 production, are the cause of severe pathologic disorders, as in asthma or hypereosinophilic syndromes. (dadamo.com)
- A high number of eosinophils (eosinophilia) are often linked to a variety of disorders. (medlineplus.gov)
Causes of eosinophilia4
- Eosinophil biology and causes of eosinophilia. (mayoclinic.org)
- and (3) an absence of other causes of eosinophilia, such as parasite infestation (most common cause of eosinophilia worldwide), allergy (most common cause of eosinophilia in the United States), malignancy, and collagen-vascular disease. (medscape.com)
- However, due to advances in the diagnostic techniques, secondary causes of eosinophilia can be identified in a proportion of cases that would have otherwise been classified as idiopathic hypereosinophilic syndrome. (medscape.com)
- Idiopathic eosinophilia is a diagnosis of exclusion when secondary and clonal causes of eosinophilia are excluded. (medscape.com)
Infiltrates2
- Daptomycin-induced pulmonary infiltrates with eosinophilia. (medscape.com)
- A chronic inflammatory disease characterized by benign enlargement of cervical LYMPH NODE and SALIVARY GLANDS with increased levels of IMMUNOGLOBULIN E. Unlike ANGIOLYMPHOID HYPERPLASIA WITH EOSINOPHILIA it involves eosinophil infiltrates in lymph node and salivary glands and mostly found in Asian males. (bvsalud.org)
Hypereosinophilia7
- Familial eosinophilia is a rare congenital disorder characterized by the presence of sustained elevations in blood eosinophil levels that reach ranges diagnostic of eosinophilia (i.e. 500-1500/microliter) or, far more commonly, hypereosinophilia (i.e. >1,500/microliter). (wikipedia.org)
- Individuals with familial eosinophilia exhibit hypereosinophilia presumably from birth (earliest documentation at 4 months of age). (wikipedia.org)
- Eosinophilia, hypereosinophilia, and hypereosinophilic syndrome. (mayoclinic.org)
- Extreme hypereosinophilia with multiple abnormal findings including pulmonary ground-glass opacity lesions and mononeuritis multiplex was consistent with hypereosinophilic syndrome. (biomedcentral.com)
- Hypereosinophilic syndrome (HES), defined as hypereosinophilia demonstrated on at least two different occasions along with associated end organ damage. (clinlabnavigator.com)
- PURPOSE OF REVIEW: Hypereosinophilic syndromes (HESs) are disorders characterized by sustained blood or tissue hypereosinophilia or both with subsequent damage to various organs due to eosinophilic infiltration and release of mediators. (wustl.edu)
- SUMMARY: The contemporary definition of the hypereosinophilic syndromes encompasses a range of eosinophilic disorders characterized by chronic blood hypereosinophilia often with eosinophil-mediated damage to various organs. (wustl.edu)
Systemic8
- None (0%) of 57 patients with hypereosinophilic syndrome but 10 (56%) of 19 patients with systemic mast cell disease associated with eosinophilia (SMCD-eos) carried the mutated FIP1L1-PDGFRA . (medscape.com)
- The secondary subtypes may be divided into two groups: systemic eosinophilic disorders (ie, hypereosinophilic disorders) and noneosinophilic disorders (eg, celiac disease , inflammatory bowel disease , vasculitis). (medscape.com)
- An interstitial deletion del(4)(q12q12) generating a FIP1L1-PDGFRA fusion gene is observed in diverse eosinophilia-associated hematologic disorders like hyperseosinophilic syndrome (HES), systemic mastocytosis (SM) and chronic eosinophilic leukemia (CEL). (atlasgeneticsoncology.org)
- Manifestations of drug-induced eosinophilia can range from an asymptomatic eosinophilia to clinically significant end-organ involvement, such as the drug reaction with eosinophilia and systemic symptoms syndrome (DRESS). (clinlabnavigator.com)
- Primary EGIDs are associated with atopy and other allergic conditions, whereas secondary EGIDs are associated with underlying systemic diseases or hypereosinophilic syndrome. (elsevierpure.com)
- Drug reaction with eosinophilia and systemic symptoms (DRESS) is a severe hypersensitivity drug reaction involving the skin and multiple internal organ systems. (biomedcentral.com)
- We believe that cysteinyl leukotriene type 1 receptor antagonists are safe and effective drugs for most patients with asthma but caution is needed for those with more severe disease who require systemic corticosteroids, especially if they show characteristics of the atypical allergic diathesis seen in the prodromal phase of Churg-Strauss syndrome. (lookformedical.com)
- Eosinophilic Granulomatosis with Polyangiitis (EGPA) Eosinophilic granulomatosis with polyangiitis is a systemic small- and medium-vessel necrotizing vasculitis, characterized by extravascular granulomas, eosinophilia, and tissue infiltration. (merckmanuals.com)
Etiology1
- Hypereosinophilic syndrome etiology can involve (1) primitive involvement of myeloid cells, essentially due to the occurrence of an interstitial chromosomal deletion on band 4q12 leading to the creation of the FIP1L1-PDGFRA fusion gene (F/P + variant), or (2) increased interleukin (IL)-5 production by a clonally expanded T-cell population (lymphocytic variant), most frequently characterized by a CD3 - CD4 + phenotype. (medscape.com)
Granulomatosis with Polyangiitis4
- The diagnosis of idiopathic hypereosinophilic syndrome poses a dilemma because clinical manifestation and serum biomarkers are similar to those of eosinophilic granulomatosis with polyangiitis. (biomedcentral.com)
- Only a few cases have been reported where coronavirus disease 2019 may have caused the new onset or exacerbation of eosinophilic granulomatosis with polyangiitis or idiopathic hypereosinophilic syndrome. (biomedcentral.com)
- Since glucocorticoids are a standard therapy for both idiopathic hypereosinophilic syndrome and eosinophilic granulomatosis with polyangiitis, we initiated glucocorticoids following a multidisciplinary discussion. (biomedcentral.com)
- Given the patient's history of recurrent sinusitis, asthma, eosinophilia, and coronary aneurysms, we diagnosed eosinophilic granulomatosis with polyangiitis ( Churg-Strauss syndrome , CSS) and cardiac involvement, and recommended high-dose corticosteroid treatment. (medscape.com)
Asthma6
- Ozdemir O. Loeffler's syndrome: a type of eosinophilic pneumonia mimicking community-acquired pneumonia and asthma that arises from Ascaris lumbricoides in a child. (medscape.com)
- We present the case of a 48-year-old Japanese woman with history of asthma who developed deteriorating symptoms of insidiously developed idiopathic hypereosinophilic syndrome following asymptomatic coronavirus disease 2019. (biomedcentral.com)
- She had a history of bronchial asthma, allergic rhinitis, and oral allergy syndrome to melon and watermelon with eosinophilia. (biomedcentral.com)
- Churg-Strauss syndrome (Figure 114) is a small vessel vasculitis occurring in patients with asthma. (hrctpatternrecognition.com)
- The picture is very unspecific, and consequently diagnosis is based on a typical triad of small vessel vasculitis, asthma and eosinophilia. (hrctpatternrecognition.com)
- In other inflammatory diseases associated with eosinophilia, such as allergic asthma, aspirin-intolerant asthma and nasal polyposis, local eosinophil accumulation closely correlates with tissue cysteinyl LT (CysLT) concentration 9 , 10 . (ersjournals.com)
Eosinophil count3
- Acute eosinophilic pneumonia is not a likely differential diagnosis as typically this presents with a normal blood eosinophil count but sputum or BAL eosinophilia. (ersjournals.com)
- Familial eosinophilia is an autosomal dominant disorder with a stable eosinophil count and a benign clinical course. (medscape.com)
- Eosinophilia is defined as the presence of an absolute eosinophil count of more than 500 per microliter (uL) of blood. (clinlabnavigator.com)
Infiltration2
- This infiltration is necessary for tissue damage to occur because patients with peripheral eosinophilia due to other causes (eg, eosinophilic pneumonia) do not develop pathology similar to hypereosinophilic syndrome. (medscape.com)
- Marked and sustained eosinophilia eventually leads to eosinophilic infiltration and functional damage of peripheral organs, most commonly the heart, skin, lungs, or nervous system. (atlasgeneticsoncology.org)
Myeloid4
- Baranger L, Sazpiro N, Gardais J, Hillion J, Derre J, Francois S, Blanchet O, Boasson M, Berger R: Translocation t(5;12)(q31-q33;p12-p13): A non-random translocation associated with a myeloid disorder with eosinophilia. (karger.com)
- In the recent fifth edition of the World Health Organization classification, similar to the recent update to the International Consensus Classification, the category was renamed to "myeloid/lymphoid neoplasms with eosinophilia and tyrosine kinase gene fusions" and both classifications added novel subtypes with new JAK2 rearrangements (e.g. (nature.com)
- However, long-term follow-up and X-linked clonality studies indicate that at least some patients with hypereosinophilic syndrome have an underlying clonal myeloid malignancy or a clonal or phenotypically abnormal T-cell population, suggesting a true secondary process. (medscape.com)
- The 2008 World Health Organization (WHO) classification system considers five broad categories of myeloid malignancies: acute myeloid leukemia (AML), myelodysplastic syndrome (MDS), myeloproliferative neoplasms (MPNs), MDS/MPN overlap, and molecularly characterized MPN with eosinophilia 1 ( Table 78-1 ). (mhmedical.com)
Peripheral and tissue eosinophilia1
- Diagnosis may sometimes be difficult but it can be achieved with the help of endoscopy plus mucosal biopsies, while peripheral and tissue eosinophilia supported by the findings of radiology, ultrasound and computed tomography can establish the diagnosis in the majority of cases. (openarchives.gr)
Absence of peripheral eosinophilia2
- Eosinophilic gastrenteritis should be considered in the differential diagnosis of patients with unexplained gastrointestinal symptoms even in the absence of peripheral eosinophilia. (openarchives.gr)
- However, pulmonary eosinophilia may occur in the absence of peripheral eosinophilia. (merckmanuals.com)
Symptoms5
- These individuals are generally detected on routine blood cell counts and at the time of diagnosis present without symptoms or at least no symptoms related to their eosinophilia. (wikipedia.org)
- Symptoms of Löffler syndrome are usually mild or absent and tend to spontaneously resolve after several days or, at most, after 2-3 weeks. (medscape.com)
- however, upon their withdrawal, the symptoms and esophageal eosinophilia recurred. (curehunter.com)
- Symptoms of DRESS syndrome often develop 2 to 8 weeks after initiation of a new drug. (clinlabnavigator.com)
- Diagnosis is often challenging and relies on symptoms, imaging findings, histologic confirmation of tissue eosinophilia, and correlation with peripheral eosinophilia. (elsevierpure.com)
Diagnosis3
- Normal cellularity with eosinophilic proliferation in the bone marrow and negative FIP1L1 - PDGFRA raised the diagnosis of idiopathic hypereosinophilic syndrome. (biomedcentral.com)
- Advances in diagnosis and treatment of eosinophilia. (wustl.edu)
- We made the diagnosis after a live nematode was removed from the brain of a 64-year-old woman who was immunosuppressed for a hypereosinophilic syndrome diagnosed 12 months earlier. (cdc.gov)
Disorders6
- https://www.merckmanuals.com/professional/hematology-and-oncology/eosinophilic-disorders/eosinophilia. (mayoclinic.org)
- FIP1L1-PDGFRA associated hypereosinophilic disorders are sensitive to treatments with tyrosine kinase inhibitors such as imatinib mesylate (imatinib). (atlasgeneticsoncology.org)
- Eosinophilia and eosinophil-related disorders. (medlineplus.gov)
- Absolute eosinophilia occurs in benign conditions such as allergic reactions and infectious diseases as well as neoplastic disorders such as myeloproliferative and lymphoproliferative diseases. (clinlabnavigator.com)
- Eosinophilic gastrointestinal disorders (EGIDs) are inflammatory conditions of the gastrointestinal tract that are characterized by tissue eosinophilia and end-organ dysfunction or damage. (elsevierpure.com)
- A heterogeneous group of disorders with the common feature of prolonged eosinophilia of unknown cause and associated organ system dysfunction, including the heart, central nervous system, kidneys, lungs, gastrointestinal tract, and skin. (lookformedical.com)
Abnormalities3
- In addition, some patients with hypereosinophilic syndrome present with features typical of MPDs, such as hepatosplenomegaly, the presence of leukocyte precursors in the peripheral blood, increased alkaline phosphatase level, chromosomal abnormalities, and reticulin fibrosis. (medscape.com)
- Evaluation revealed CSF eosinophilia, background slowing on EEG, and periventricular MRI abnormalities. (johnshopkins.edu)
- The onset of this syndrome may occur at any time from early childhood onwards, and may include eosinophilia and osteoarticular and dental abnormalities. (journalcra.com)
Manifestations2
- Although high eosinophil levels are associated with certain diseases and thought to contribute to the tissue destruction found in many other eosinophilia-related diseases (see clonal eosinophilia), clinical manifestations and tissue destruction related to the eosinophilia in familial eosinophilia is uncommon: this genetic disease typically has a benign phenotype and course compared to other congenital and acquired eosinophilic diseases. (wikipedia.org)
- The neurologic manifestations in hypereosinophilic syndrome are. (koreamed.org)
Acute6
- [ 15 ] In addition, there are documented cases of acute transformation to either AML or granulocytic sarcoma in some cases of hypereosinophilic syndrome after an interval as long as 24 years. (medscape.com)
- Although the relationship between asymptomatic coronavirus disease 2019 and acute idiopathic hypereosinophilic syndrome exacerbation was uncertain, the chronological order of the symptomatic development suggested a possible link. (biomedcentral.com)
- She had a positive polymerase chain reaction (PCR) test for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) 5 weeks before her visit, which was detected because she was in close contact with her husband who had COVID-19. (biomedcentral.com)
- The patient subsequently developed acute respiratory distress syndrome (ARDS) followed by rash and acute interstitial nephritis. (biomedcentral.com)
- Described here is a case of vancomycin induced DRESS syndrome with an atypical presentation, which manifested initially with acute respiratory distress syndrome (ARDS), followed by rash, fever, and acute interstitial nephritis. (biomedcentral.com)
- First described in 1998, Paediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal infections (PANDAS) is a specific case of Paediatric Acute-onset Neuropsychiatric Syndrome (PANS) (Quagliarello et al. (isom.ca)
Idiopathic eosinophilia2
- Acquired eosinophilia is further divided into secondary, clonal, and idiopathic eosinophilia. (medscape.com)
- Hypereosinophilic syndrome is a rare disease presenting with idiopathic eosinophilia and multiple organ involvement, including the skin, lungs, gastrointestinal tract, heart, and nervous system. (biomedcentral.com)
Corticosteroids1
- Hypereosinophilic syndrome with isolated Loeffler's endocarditis: complete resolution with corticosteroids. (medscape.com)
PDGFRA5
- Fip1-like1-platelet-derived growth factor receptor alpha chain ( FIP1L1-PDGFRA ) mutation has been described in adult patients with hypereosinophilic syndrome. (medscape.com)
- None of 8 patients with reactive eosinophilia demonstrated defects in FIP1L1-PDGFRA, whereas the rate of FIP1L1-PDGFRA in the remaining 81 patients with primary eosinophilia was 14% (11 patients). (medscape.com)
- The cause of FIP1L1-PDGFRA associated hypereosinophilic syndrome is unknown as well as its association with predominantly male sex. (atlasgeneticsoncology.org)
- However, in unselected patients with eosinophilia only 3% of were found to carry the FIP1L1-PDGFRA fusion (Pardanani et al. (atlasgeneticsoncology.org)
- The literature now favors the view that cases of idiopathic hypereosinophilic syndrome with FIP1L1 indeed represent chronic eosinophilic leukemia, because these patients have a molecular genetic abnormality, specifically an FIP1L1-PDGFRA fusion gene. (medscape.com)
Inflammatory1
- Guillain-Barré syndrome and multisystem inflammatory syndrome in children (MIS-C), which are similar to Kawasaki disease, are well-known complications. (biomedcentral.com)
IHES1
- A thorough understanding of the idiopathic hypereosinophilic syndrome (IHES) and further optimization of diagnostic work-up procedures are warranted. (oncotarget.com)
Organ1
- Hypereosinophilic syndrome (HES) is characterized by sustained non-clonal blood and tissue eosinophilia, leading to end-organ damage. (elsevierpure.com)
Patients12
- [ 4 ] In 3 patients with T-cell lymphomas, eosinophilia has been correlated with increased production of these cytokines by the lymphomas. (medscape.com)
- Also, because some patients with hypereosinophilic syndrome have concomitant neutrophilia, factors other than IL-5 are likely involved. (medscape.com)
- Here we propose comprehensive response criteria based on the heterogenous clinical presentations of patients with MLN with eosinophilia and tyrosine kinase gene fusions. (nature.com)
- Patients with eosinophilic gastroenteritis have elevated IgE and eosinophilia of tissue and blood. (medscape.com)
- Patients with hypereosinophilic syndrome historically carried a poor prognosis before the successful therapeutic application of tyrosine kinase inhibitors. (atlasgeneticsoncology.org)
- Patients with drug-induced pulmonary eosinophilia commonly have crackles on physical examination. (medscape.com)
- BACKGROUND: Eosinophilia in haemodialysis patients probably results from allergy to haemodialysis-related materials, including dialyzer membranes. (dadamo.com)
- METHODS: We enrolled seven patients who were on regular haemodialysis and had sustained eosinophilia. (dadamo.com)
- Other connective tissue diseases seen in mast cell patients include Marfan Syndrome and Loeys-Dietz Syndrome. (mastattack.org)
- The patients have eosinophilia, and lung changes are seen in approximately half of cases. (hrctpatternrecognition.com)
- We assessed the clinicopathological features of 28 patients with peripheral neuropathy associated with Churg-Strauss syndrome. (lookformedical.com)
- A large proportion of patients demonstrates peripheral eosinophilia. (openarchives.gr)
Involvement2
- Cardiac involvement is the most common cause of mortality in hypereosinophilic syndrome. (medscape.com)
- Eosinophilia and lung involvement differentiate this disease from POLYARTERITIS NODOSA. (lookformedical.com)
Reactive eosinophilia3
- Furthermore, reactive eosinophilia samples could be differentiated from known- and suspected clonal eosinophilia samples based on 285 differentially methylated CpG sites corresponding to 128 differentially methylated genes. (oncotarget.com)
- In addition, we identified a DNA methylation signature that is relevant for distinguishing clonal and suspected clonal eosinophilia from reactive eosinophilia per se , which may be useful in daily clinical work. (oncotarget.com)
- Eosinophilia arises either as an intrinsic, clonal disorder or in the majority of cases, secondary to extrinsic conditions, so-called reactive eosinophilia [ 2 - 4 ]. (oncotarget.com)
Organs1
- Hypereosinophilic syndrome (HES) is a myeloproliferative disorder (MPD) characterized by persistent eosinophilia that is associated with damage to multiple organs. (medscape.com)
Clonal1
- Clonal eosinophilia is diagnosed by bone marrow histology, cytogenetics, and molecular genetics. (medscape.com)
Persistent1
- This and other factors-for example, eosinophil-apoptosis impairment through high levels of soluble CD95-might account for the persistent eosinophilia in active CSS. (medscape.com)
Drug-induced1
- Saint-Pierre MD, Moran-Mendoza O. Acetaminophen Use: An Unusual Cause of Drug-Induced Pulmonary Eosinophilia. (medscape.com)
Chronic1
- Hyper immunoglobulin (Ig) E syndrome is a rare complex immunoregulatory disorder characterized by hyperglobulinemia, recurrent bacterial infections and chronic eczematous dermatitis. (journalcra.com)
Biopsy1
- Sometimes, tissue eosinophilia may be found using a biopsy. (mayoclinic.org)
Cutaneous2
- Cutaneous features of hypereosinophilic syndrome are described in a review article. (medscape.com)
- Clinical overview of cutaneous features in hypereosinophilic syndrome. (medscape.com)
Primary1
- Eosinophilia can be reactive (secondary) or the primary manifestation of a hematologic disorder. (msdmanuals.com)
Vasculitis1
- Necrotizing vasculitis mediated by cytotoxic T cells, leading to ischaemic changes, appears to be a major cause of Churg-Strauss syndrome-associated neuropathy. (lookformedical.com)