Differential Diagnosis for Ascending Paresthesia and Marked Eosinophilia in an 18-Year-Old
Single Most Likely Diagnosis
- Loeffler's Syndrome: This is a type of eosinophilic pneumonia that can present with marked eosinophilia and neurological symptoms due to hypereosinophilia syndrome, which can cause ascending paresthesia. The condition is often associated with parasitic infections or can be idiopathic.
Other Likely Diagnoses
- Churg-Strauss Syndrome: A form of vasculitis that is characterized by asthma, eosinophilia, and vasculitic symptoms, which can include neurological manifestations such as paresthesia. The marked eosinophilia and potential for neurological involvement make it a plausible diagnosis.
- Parasitic Infections (e.g., Toxocariasis, Hookworm): Certain parasitic infections can cause marked eosinophilia and, in rare cases, neurological symptoms if the parasites infect the nervous system.
- Hypereosinophilic Syndrome (HES): A condition characterized by persistent and marked eosinophilia that can lead to organ damage, including the nervous system, presenting with symptoms like ascending paresthesia.
Do Not Miss Diagnoses
- Neurocysticercosis: Caused by the pork tapeworm (Taenia solium), this condition can lead to neurological symptoms, including paresthesia, and eosinophilia. It's crucial to consider this diagnosis due to its potential severity and the need for specific treatment.
- Guillain-Barré Syndrome with Eosinophilia: Although rare, Guillain-Barré Syndrome can occasionally present with eosinophilia, making it a critical diagnosis not to miss due to its rapid progression and need for prompt treatment.
Rare Diagnoses
- Eosinophilic Granuloma with Polyangiitis (EGPA): Formerly known as Churg-Strauss syndrome, but in this context, referring to a rare variant with specific organ involvement, including the nervous system, which could present with paresthesia and eosinophilia.
- Tropical Eosinophilia: A condition seen in tropical regions, characterized by marked eosinophilia and pulmonary symptoms, but can occasionally have neurological manifestations.
- Eosinophilic Meningitis: Caused by parasitic infections (e.g., Angiostrongylus cantonensis), this condition can present with eosinophilia and neurological symptoms, including paresthesia, but is relatively rare and typically associated with specific exposures.