PRIMARY care physicians are pivotal in the early recognition and referral of rare eosinophilic diseases, such as hypereosinophilic syndrome (HES) and eosinophilic granulomatosis with polyangiitis (EGPA), which remain underdiagnosed despite their serious multisystem impact.
These chronic inflammatory conditions, though considered rare, may be more prevalent than reported due to diagnostic delays and clinical overlap with more common diseases. A new study emphasizes that primary care physicians (PCPs) are often the first point of contact and must remain vigilant for red flag indicators that could prompt timely referral and intervention.
Both HES and EGPA present with a spectrum of symptoms affecting multiple organ systems. Key diagnostic clues include elevated eosinophil counts, defined as ≥10% of total peripheral white blood cells or ≥1,000 cells/μL, especially when persistent despite systemic corticosteroid use. Other concerning features include refractory asthma that requires repeated or prolonged corticosteroids, reduced responsiveness to asthma therapies, and signs of extrapulmonary involvement such as gastrointestinal, dermatologic, neurologic, or cardiac symptoms.
Systemic features that evolve or worsen over weeks to years should also heighten clinical suspicion. Recognizing these patterns early and coordinating specialist referral can lead to accurate diagnosis and more effective treatment pathways, potentially preventing long-term damage and improving outcomes.
The study underscores the critical role of PCPs in bridging the diagnostic gap. With increased awareness and clinical suspicion of HES and EGPA, PCPs can play an essential role in initiating further testing and orchestrating multidisciplinary care strategies. Improved vigilance may help more patients receive appropriate therapy before irreversible complications develop.
Reference:
Shum M et al. Primary care physicians play a crucial role in diagnosing and managing rare eosinophilic diseases: HES and EGPA. Front Med (Lausanne). 2025;12:1568770.
