Differential Diagnosis for Elevated Eosinophils in a Smoker on Eliquis

Single Most Likely Diagnosis

• Chronic obstructive pulmonary disease (COPD) with eosinophilic exacerbation: This is a common condition in smokers, and eosinophilic exacerbations can occur, leading to elevated eosinophil counts. The patient's smoking history increases the likelihood of this diagnosis.

Other Likely Diagnoses

• Asthma: Another common condition in smokers, asthma can cause elevated eosinophils, especially if the patient is experiencing an exacerbation. The presence of eosinophilia supports this diagnosis.
• Allergic bronchopulmonary aspergillosis (ABPA): This condition is more common in asthmatic patients and can cause elevated eosinophils. The patient's smoking history and potential for asthma increase the likelihood of ABPA.
• Parasitic infection: Although less common in smokers, parasitic infections can cause elevated eosinophils. The patient's use of Eliquis (a anticoagulant) may increase the risk of certain infections.

Do Not Miss Diagnoses

• Hypereosinophilic syndrome (HES): A rare but potentially life-threatening condition, HES can cause significant organ damage if left untreated. Although unlikely, it is crucial to consider this diagnosis due to its severity.
• Eosinophilic granulomatosis with polyangiitis (EGPA): Formerly known as Churg-Strauss syndrome, EGPA is a rare autoimmune disorder that can cause elevated eosinophils and is often associated with asthma. The patient's smoking history and potential for asthma increase the importance of considering this diagnosis.
• Acute eosinophilic pneumonia: A rare but potentially life-threatening condition, acute eosinophilic pneumonia can cause significant respiratory distress and requires prompt treatment.

Rare Diagnoses

• Loeffler's syndrome: A rare condition characterized by migratory pulmonary infiltrates and eosinophilia, Loeffler's syndrome is often associated with parasitic infections or other underlying conditions.
• Tropical pulmonary eosinophilia: A rare condition caused by a hypersensitivity reaction to filarial parasites, tropical pulmonary eosinophilia can cause elevated eosinophils and respiratory symptoms.
• Eosinophilic leukemia: A rare type of leukemia, eosinophilic leukemia can cause elevated eosinophils and is often associated with other hematologic abnormalities.