Resolution of transient, marked eosinophilia, hyperimmunoglobulinemia E, and refractory eczematous dermatitis after the treatment of pancreatic pseudocysts.

E osinophilia, defined as greater than 450 eosinophils/ L, can occur in various disease processes, including infectious, allergic, neoplastic, and primary hematologic disorders. Marked eosinophilia ([1500 eosinophils/ L) can be a diagnostic dilemma because blood eosinophilia rarely exceeds 1500/ L in atopic/allergic diseases. Hyperimmunoglobulinemia E is seen in allergic, parasitic, and primary immunodeficiency diseases. Although a hallmark of allergic disease is the infiltration of tissues with increased numbers of eosinophils, there is little evidence for immunoglobulin Eedependent function of eosinophils. Primary immunodeficiency disease, autosomal dominant hyperimmunoglobulin E syndrome or Job syndrome, is caused by mutations of STAT3 gene, and shows greater than 2000 IU/mL of a peak serum immunoglobulin E, eosinophilia, and eczematous dermatitis. Thus, T-cell immunodeficiency also causes eosinophilia, hyperimmunoglobulinemia E, and eczematous dermatitis. Pancreatic diseases occasionally cause eosinophilia. Although both eosinophilia and hyperimmunoglobulinemia E are linked with eczematous dermatitis, skin manifestations associated with pancreatic diseases such as pancreatic panniculitis are uncommon. We present a case of a 60-year-old Japanese man with pancreatitis and refractory eczematous dermatitis accompanied with transient, marked eosinophilia and