A 28-Year-Old Man With New Wheezing and an Elevated Blood Count

Introduction. A 28-year-old man was referred to the allergy/immunology clinic by his primary care physician for recent episodes of wheezing and an elevated blood count.

History. The episodic wheezing was noted about 4 months prior. The episodes do not seem to be associated with exposures to smoke or the outdoors, although they can appear at any time. The patient does not smoke and has no pets. He has been using inhalers, which have provided symptomatic relief.

A routine complete blood count (CBC) was obtained and revealed a mildly elevated eosinophil count of 1200K. Prior to the elevated eosinophil count, the patient’s past medical history was unremarkable. The patient has no history of significant atopy or childhood asthma. Other than the inhaler, he was on no other medications either currently or prior to symptom onset. He noted some ongoing fatigue coincident to the starting of wheezing, which he attributed to perhaps some loss of sleep.

It should be noted that about 18 months ago, the patient had an episode of urticarial with erythema raised vesicular lesions, which flattened into purpuric lesions ("palpable purpura"). A copy of the old record showed a skin biopsy positive for leukocytoclastic vasculitis.

Diagnostic testing. A set of laboratory tests showed normal C-reactive protein levels (< 0.3 mg/dL) and sedimentation rate of 2 mm/hr (normal range = 0 to 15 mm/hr). Urinalysis was positive for red blood cells and 1+ positive for protein. Chest x-ray and electrocardiogram were both within normal ranges. The patient’s CBC was within normal ranges for hemoglobin and platelets. The patient’s white blood cell count was slightly elevated at 13,800 K (normal range = 4500K to 11,000K) with 45% mature eosinophils (eosinophil absolute count = 6100K.)