Hoofbeats: A 29M with Cough, Abdominal Pain, Fever

1. Hypereosinophilia is defined as an absolute eosinophil count > 1.5 x 109/L (or >1500 cells/microL) in the peripheral blood on two examinations separated in time by at least one month and/or pathologic confirmation of tissue hypereosinophilia. Hypereosinophilic syndrome is defined by the association of hypereosinophilia with eosinophil-mediated organ damage and/or dysfunction.
2. Mnemonics and schemata are both mental tools that can aid memory formation, organization, and retrieval. Mnemonics are useful for quick recall of information especially in a large quantity. Wherera storage of data using schemata is bound by meaning and often provides a systematic approach to a clinical problem. While Mnemonics are powerful tools in early medical education and can pack a lot of information, it is important to remember to explore material not limited to existing mnemonics if we wish to master the particular subjects.
3. Framing bias in medicine is often loosely defined as “The manner in which data is presented can affect decision making.” There are in fact different types of framing including risky-choice, attribute framing, and goal framing. The different types of framing have not been thoroughly studied in medicine and it is difficult to measure how prevalent and pervasive framing bias is in our everyday clinical practice. 
4. While a data value lands on the extreme end of the spectrum, it often but not always carries significant clinical importance. Knowing that we tend to be intrinsically sensitive to rare findings, caution is needed when we assign such findings appropriate diagnostic weight.
5. Hypereosinophilia in malignancy can be reactive or secondary in solid tumors, versus primary or clonal from myeloproliferative neoplasms. Eosinophilia in solid tumors is rare but has been reported in many types of neoplasms including lung, gastrointestinal, hepatocellular, thyroid, and soft tissue sarcomas.

Contributors

Cindy Fang, MD - Host, Editor

John Hwang, MD - Host, Editor

Solon Kellehar, MD - Host, Case narration

Anand Viswanathan, MD, PhD - Guest

Reviewers

Ann Marie Kumfer, MD*

Ashley Meyer, PhD

Those named above unless otherwise indicated have no relationships with any entity producing, marketing, reselling, or distributing health care goods or services consumed by, or used on, patients.

*Dr. Kumfer reports receiving honoraria from the Human Diagnosis Project. This relationship is not relevant to the content she is controlling.

Release Date: November 25, 2020

Expiration Date: November 25, 2023

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