CSF Eosinophilia Following Myelography

To the Editor.— The article by H. Preston Holley, Jr, MD, and Mohamed S. Al-Ibrahim, MD (242:2432, 1979), reported on a patient having CSF eosinophilia following myelography. In the report the authors suggest that "foreign material in the spinal canal can, on occasion, evoke an eosinophilic response by some unknown mechanism." I suggest that eosinophil chemotactic factor (ECF-A) could be responsible for the eosinophilia. This potent mediator is preformed in basophil and mast cell granules and can be released by several mechanisms. 1 Iophendylate (Pantopaque) injection, like other contrast media, can act directly on basophils and mast cells, causing mediator release. 2 Second, contrast media can activate the complement sequence, 3 producing C3a and C5a. These anaphylotoxins cause the release of mediators of inflammation, 4 which includes ECF-A. Finally, an iophendylate injection can rarely cause a type I (IgE mediated) Gell-and-Coombs hypersensitivity reaction 5 that can be associated with the