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High Eosinophilic Count, Negative Stool Test, Headache, Cracking In Occipital Area When Moving Head. Opinion?
Question: Dear Sir, I have a high eosinophilic bloodcount (13% of WBC) since 2 months. During the first month I had stomach and bowl problems (indigestion, pressure in the stomach and irregular stools). After these problems disappeared, my doctor has done a stool test (PCR) to find parasites but it was negative. Now, since 2 weeks, I suffer from daily headaches (which I never had in my life), a lot of cracking sounds in my occiputal area when I move my head and the eosinophilic bloodcount is still high (there is no fever). I'm living in Greece. What's your opinion?
Hi AAAAA,
Thank you for contacting Healthcare Magic.
The commonest cause of headache in occipital area is muscle tension headache, also referred to as tension headache. In this condition, there is pain at the back of head and neck, which is more in the evenings. Generally, there is no vomiting or any other symptoms. There may be tenderness to touch and people feel better with massage of the affected area. The medicines useful are tricyclic antidepressants at a low dose such as dothiepin or amitryptiline.
Other common condition causing pain in this case could be cervical spondylitis. An X-ray of the cervical spine would be useful in confirming the diagnosis. Cracking sounds at the back of head and neck may occur in this condition. If confirmed, treatment is mainly with the use of analgesics (as and when necessary) and neck physiotherapy.
If your headaches do not subside, a CT scan or MRI of the brain may be required.
Generally, there is no connection between blood eosinophilia and headaches. Eosinophilia can occur with parasitic infections. One such infection can occur in brain too (neurocysticercosis), but it is not common in Europe.
I hope it clarifies. Please get back if you have any further queries.
Best wishes,
Dr Sudhir Kumar MD DM (Neurology)
XXXXXXX Consultant Neurologist
Apollo Hospitals, Hyderabad, India
Thank you for contacting Healthcare Magic.
The commonest cause of headache in occipital area is muscle tension headache, also referred to as tension headache. In this condition, there is pain at the back of head and neck, which is more in the evenings. Generally, there is no vomiting or any other symptoms. There may be tenderness to touch and people feel better with massage of the affected area. The medicines useful are tricyclic antidepressants at a low dose such as dothiepin or amitryptiline.
Other common condition causing pain in this case could be cervical spondylitis. An X-ray of the cervical spine would be useful in confirming the diagnosis. Cracking sounds at the back of head and neck may occur in this condition. If confirmed, treatment is mainly with the use of analgesics (as and when necessary) and neck physiotherapy.
If your headaches do not subside, a CT scan or MRI of the brain may be required.
Generally, there is no connection between blood eosinophilia and headaches. Eosinophilia can occur with parasitic infections. One such infection can occur in brain too (neurocysticercosis), but it is not common in Europe.
I hope it clarifies. Please get back if you have any further queries.
Best wishes,
Dr Sudhir Kumar MD DM (Neurology)
XXXXXXX Consultant Neurologist
Apollo Hospitals, Hyderabad, India
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dear Doctor XXXXXXX
Thank you for your fast and clear reply! I would like to ask you some follow-up questions:
I would like to know why I (still) have blood eosinophilia. The PCR stool test was negative, so no PRESENT parasitic infection of the digestive tract, but maybe:
A) my body has eliminated a possible infection by its own defense mechanism;
or
B) the parasite has migrated to other parts of the body.
In case A: How long will there be blood eosinophilia after the elimination of the parasite in the digestive tract?
In case B: Can parasitic infections (in relation to my present symptoms) migrated to / in other parts of the body (CNS, organs, tissue, etcetera) be diagnosed in other ways than - for example - MRI, CT, biopsy or CSF collection?
You mentioned neurocysticercosis (caused by the larvae of the tape worm, migrated to - for example - the CNS): don't you think I should have noticed an intestinal tape worm (because of segments in my stool) before a possible migration of the embryos/larvae took place?
In conclusion: IF there is (was) no parasitic infection at all and IF your assumption about possible muscle tension or cervical spondylitis is wrong, why do I still have eosinophilia with respect to the symptoms I have described? I have looked at WikiPedia for the possible causes of eosinophilia: there are many causes, but the symptom pictures of most of them don't really fit with my symptoms (yet!). Is there something else that my physician and I could have overlooked?
Thank you in advance for your next reply!
Regards,
AAAAA
Thank you for your fast and clear reply! I would like to ask you some follow-up questions:
I would like to know why I (still) have blood eosinophilia. The PCR stool test was negative, so no PRESENT parasitic infection of the digestive tract, but maybe:
A) my body has eliminated a possible infection by its own defense mechanism;
or
B) the parasite has migrated to other parts of the body.
In case A: How long will there be blood eosinophilia after the elimination of the parasite in the digestive tract?
In case B: Can parasitic infections (in relation to my present symptoms) migrated to / in other parts of the body (CNS, organs, tissue, etcetera) be diagnosed in other ways than - for example - MRI, CT, biopsy or CSF collection?
You mentioned neurocysticercosis (caused by the larvae of the tape worm, migrated to - for example - the CNS): don't you think I should have noticed an intestinal tape worm (because of segments in my stool) before a possible migration of the embryos/larvae took place?
In conclusion: IF there is (was) no parasitic infection at all and IF your assumption about possible muscle tension or cervical spondylitis is wrong, why do I still have eosinophilia with respect to the symptoms I have described? I have looked at WikiPedia for the possible causes of eosinophilia: there are many causes, but the symptom pictures of most of them don't really fit with my symptoms (yet!). Is there something else that my physician and I could have overlooked?
Thank you in advance for your next reply!
Regards,
AAAAA
Thank you for getting back.
I must appreciate your analytical mind and your thoughtful reasoning!
As you mentioned, right now, you do not have any symptoms of infection in any part of the body. So, doing any test to diagnose the occult infection (if there is one now) is very challenging. Which body part will we investigate? Also, it is not recommended to do any test till symptoms emerge.
Regarding how long eosinophilia can persist, there is no definite answer. But I have seen it persist for 4-6 weeks after the infection has subsided. Sometimes, we use a medicine Hetrazan (diethylcarbamazine, DEC) for treating eosinophilia due to parasitic infections. You can discuss this with your physician.
Regarding neurocysticercosis and tapeworms, I see one patient a week. So, in the past 17 years of my practice, I would have seen thousands of cases (it is very common in India, but luckily not so in Europe!). Most often, patients do not notice any worms in stool. However, occasionally, in stool examination, body parts of the worm may be found. Also, intestinal infection and brain infection occur at different times (there is a long gap between the two).
So, as of now, I do not think your physician has overlooked anything. Please watch for any symptoms (eosinophilia is often linked to skin and lung problems), which could give a clue to the cause of eosinophilia. If none appear, it is a good news.
Best wishes,
Dr Sudhir Kumar MD DM (Neurology) XXXXXXX Consultant Neurologist
Apollo Hospitals, Hyderabad
I must appreciate your analytical mind and your thoughtful reasoning!
As you mentioned, right now, you do not have any symptoms of infection in any part of the body. So, doing any test to diagnose the occult infection (if there is one now) is very challenging. Which body part will we investigate? Also, it is not recommended to do any test till symptoms emerge.
Regarding how long eosinophilia can persist, there is no definite answer. But I have seen it persist for 4-6 weeks after the infection has subsided. Sometimes, we use a medicine Hetrazan (diethylcarbamazine, DEC) for treating eosinophilia due to parasitic infections. You can discuss this with your physician.
Regarding neurocysticercosis and tapeworms, I see one patient a week. So, in the past 17 years of my practice, I would have seen thousands of cases (it is very common in India, but luckily not so in Europe!). Most often, patients do not notice any worms in stool. However, occasionally, in stool examination, body parts of the worm may be found. Also, intestinal infection and brain infection occur at different times (there is a long gap between the two).
So, as of now, I do not think your physician has overlooked anything. Please watch for any symptoms (eosinophilia is often linked to skin and lung problems), which could give a clue to the cause of eosinophilia. If none appear, it is a good news.
Best wishes,
Dr Sudhir Kumar MD DM (Neurology) XXXXXXX Consultant Neurologist
Apollo Hospitals, Hyderabad
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dear Doctor XXXXXXX
Thanks a lot for your compliment (maybe I should have told you before that I have a medical background, although not as a professional) and clear answers!
Sorry for bothering you again, but there is something that I would like to bring under your attention, after you mentioned skin and lung problems: I have been suffering from seborrhoeic eczema a long time, since I was 19 years old, specially on the scalp, in the face, around the sternum and at the perineum (all typical places for that kind of eczema), but it has disappeared in all those regions about 15 years ago (when I was about 40 years old) except for the perineum. In my whole life I have had some blood tests (for other reasons), but there was never a sign of eosinophilia, until 2 months ago.
Since one year I have a more problems with the eczema of the perineum than ever before: it has evolved into a seborrhoeic dermatitis (according a skin biopsy that was taken 6 weeks ago) and spread into a bigger area towards my scrotum, with a lot of redness (rash) and some chaps. In the past I could easily keep it under control with zinc ointment, but one year ago I had to start using a corstison creme (Locacorten Vioform) and an anti-fungal creme because the skin was 'damaged' too much and became sensitive to fungi (I used both cremes for 10 days and later on only sometimes a couple of days when the symptoms aggrevated, always with a good result). But since 4 months the cortison creme is not effective anymore, even not in a higher dose. I find this very strange, because usually the skin/eczema responds always to cortison, specially if you don't use the creme for a long time (which I never did because of the risk for rebound). Might there be a connection between this phenomenon and the blood eosinophilia? I realize that the perineum is not a big part of my total body skin surface, but you never know....
Thank you again in advance for your kind and professional help!
Kind regards,
XXXXXXX
Thanks a lot for your compliment (maybe I should have told you before that I have a medical background, although not as a professional) and clear answers!
Sorry for bothering you again, but there is something that I would like to bring under your attention, after you mentioned skin and lung problems: I have been suffering from seborrhoeic eczema a long time, since I was 19 years old, specially on the scalp, in the face, around the sternum and at the perineum (all typical places for that kind of eczema), but it has disappeared in all those regions about 15 years ago (when I was about 40 years old) except for the perineum. In my whole life I have had some blood tests (for other reasons), but there was never a sign of eosinophilia, until 2 months ago.
Since one year I have a more problems with the eczema of the perineum than ever before: it has evolved into a seborrhoeic dermatitis (according a skin biopsy that was taken 6 weeks ago) and spread into a bigger area towards my scrotum, with a lot of redness (rash) and some chaps. In the past I could easily keep it under control with zinc ointment, but one year ago I had to start using a corstison creme (Locacorten Vioform) and an anti-fungal creme because the skin was 'damaged' too much and became sensitive to fungi (I used both cremes for 10 days and later on only sometimes a couple of days when the symptoms aggrevated, always with a good result). But since 4 months the cortison creme is not effective anymore, even not in a higher dose. I find this very strange, because usually the skin/eczema responds always to cortison, specially if you don't use the creme for a long time (which I never did because of the risk for rebound). Might there be a connection between this phenomenon and the blood eosinophilia? I realize that the perineum is not a big part of my total body skin surface, but you never know....
Thank you again in advance for your kind and professional help!
Kind regards,
XXXXXXX
Thank you for getting back.
I went through the detailed report regarding your skin problem- eczema and dermatitis, and noted that recently it has flared up and not responding so well to treatment.
As you suspected, eosinophilia can occur in eczema and dermatitis. In earlier blood reports, eosinophilia was not found, as the disease was under control. So, I think as your skin condition improves, eosinophilia would also improve.
Best wishes,
Dr Sudhir Kumar MD DM (Neurology) XXXXXXX Consultant Neurologist
I went through the detailed report regarding your skin problem- eczema and dermatitis, and noted that recently it has flared up and not responding so well to treatment.
As you suspected, eosinophilia can occur in eczema and dermatitis. In earlier blood reports, eosinophilia was not found, as the disease was under control. So, I think as your skin condition improves, eosinophilia would also improve.
Best wishes,
Dr Sudhir Kumar MD DM (Neurology) XXXXXXX Consultant Neurologist
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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