Case 150 – update 2

Our patient has been admitted for further investigations. You feel she does not require urgent steroid therapy at this point.

You have arranged for peripheral blood cytogenetics looking for common mutations associated with primary eosinophilia. You also organise a vasculitis screen, HBV/HCV/HIV testing, stool culture, and an echo – results in progress.

She undergoes a CT CAP which shows widespread low volume lymphadenopathy above and below the diaphragm. There is no organomegaly.

The following day her eosinophil count has risen to 15×10^9/L. Her temperature is now 38.6C. As you prepare to review her on your ward round, she has a generalised tonic clonic seizure.

What are your top differentials at this point and what would you do next?

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