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Peer-reviewedCC BYCureus

Eosinophilic Esophagitis and Marked Leukocytosis in Alpha-Gal Syndrome: Infection, Allergy, or Hematologic Malignancy?

  • Mohamed Alharami1
  • Christina Kafkis2
  • Omar Alwan3
  • Ziad Suleiman4
  • Hadi Hemaidan5
  • Frhaan M Zahrawi2
5 affiliations
  1. 1Internal Medicine, Henry Ford Warren Hospital, Warren, USA.
  2. 2Internal Medicine, Prime Healthcare Olympia Fields Hospital, Olympia Fields, USA.
  3. 3Internal Medicine, Hamilton Medical Center, Hamilton, USA.
  4. 4Internal Medicine, Southwest Healthcare Medical Education Consortium, Temecula, USA.
  5. 5Internal Medicine, Herbert Wertheim College of Medicine, Florida International University, Miami, USA.
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Abstract

Alpha-gal syndrome (AGS) is a tick-borne immunoglobulin E (IgE)-mediated hypersensitivity reaction to galactose-α-1,3-galactose (alpha-gal) found in mammalian meat products. Eosinophilic gastrointestinal disorders (EGIDs), including eosinophilic esophagitis (EoE), are T helper 2 (Th2)-mediated conditions characterized by eosinophilic infiltration of the gastrointestinal tract. We present a case of a 63-year-old man with known AGS who developed dysphagia, rash, pulmonary infiltrates, gastrointestinal eosinophilic infiltrates, and marked eosinophilia. Bone marrow biopsy revealed marked hypercellularity with myeloid predominance and increased eosinophils and eosinophilic precursors. The patient met the diagnostic criteria for idiopathic hypereosinophilic syndrome (HES) based on persistent peripheral eosinophilia, eosinophilic end-organ damage, and exclusion of secondary and clonal causes. This report describes a rare presentation of AGS meeting the symptomatic and diagnostic criteria of EoE alongside a systemic eosinophilic disorder. The possible shared Th2-mediated pathophysiology of these disorders suggests that AGS could act as an immunologic trigger for these disorders, though further research is needed to establish the association.

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Cite

BibTeXRIS
BibTeX
@article{alharami2026eosinophilic,
  title = {{Eosinophilic Esophagitis and Marked Leukocytosis in Alpha-Gal Syndrome: Infection, Allergy, or Hematologic Malignancy?}},
  author = {Mohamed Alharami and Christina Kafkis and Omar Alwan and Ziad Suleiman and Hadi Hemaidan and Frhaan M Zahrawi},
  journal = {Cureus},
  year = {2026},
  month = sep,
  doi = {10.7759/cureus.116599},
  url = {https://europepmc.org/article/MED/42904267},
  note = {CC BY},
}
RIS
TY  - JOUR
TI  - Eosinophilic Esophagitis and Marked Leukocytosis in Alpha-Gal Syndrome: Infection, Allergy, or Hematologic Malignancy?
AU  - Mohamed Alharami
AU  - Christina Kafkis
AU  - Omar Alwan
AU  - Ziad Suleiman
AU  - Hadi Hemaidan
AU  - Frhaan M Zahrawi
PY  - 2026
DA  - 2026/09/20
JO  - Cureus
DO  - 10.7759/cureus.116599
UR  - https://europepmc.org/article/MED/42904267
AB  - Alpha-gal syndrome (AGS) is a tick-borne immunoglobulin E (IgE)-mediated hypersensitivity reaction to galactose-α-1,3-galactose (alpha-gal) found in mammalian meat products. Eosinophilic gastrointestinal disorders (EGIDs), including eosinophilic esophagitis (EoE), are T helper 2 (Th2)-mediated conditions characterized by eosinophilic infiltration of the gastrointestinal tract. We present a case of a 63-year-old man with known AGS who developed dysphagia, rash, pulmonary infiltrates, gastrointestinal eosinophilic infiltrates, and marked eosinophilia. Bone marrow biopsy revealed marked hypercellularity with myeloid predominance and increased eosinophils and eosinophilic precursors. The patient met the diagnostic criteria for idiopathic hypereosinophilic syndrome (HES) based on persistent peripheral eosinophilia, eosinophilic end-organ damage, and exclusion of secondary and clonal causes. This report describes a rare presentation of AGS meeting the symptomatic and diagnostic criteria of EoE alongside a systemic eosinophilic disorder. The possible shared Th2-mediated pathophysiology of these disorders suggests that AGS could act as an immunologic trigger for these disorders, though further research is needed to establish the association.
SN  - 2168-8184
ER  -