Clinical manifestation

Cutaneous findings: pruritius; angioedema, urticaria, often with dermatographism; ery-thematous, pruritic papules, plaques and nodules, with or without ulceration Cardiac findings: chest pain, dyspnea, or orthopnea

Hematologic changes: splenomegaly; thrombotic episodes

Neurologic findings: encephalopathy; cere-brovascular accidents or transient ischemic episodes

Hyperimmunoglobulin E syndrome 297

Pulmonary changes: chronic, persistent cough, usually nonproductive; dyspnea from congestive heart failure or pleural effusions; pulmonary fibrosis Rheumatologic findings: arthralgias and myalgias; occasional Raynaud phenomenon Gastrointestinal findings: abdominal pain; nausea; diarrhea; hepatomegaly

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