SHM Converge Scientific Abstract ePoster Gallery-"Pan-Positive" Review of Systems: Hypereosinophilic Syndrome in a Previously Healthy Woman

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This case describes a 36-year-old previously healthy woman who presented with decreased visual acuity, involuntary contractions of her right fourth and fifth fingers, and a history of dyspnea on exertion, hives, diffuse edema, and diarrhea. Exam showed impaired vision, reduced right-hand grip strength, involuntary finger flexion, and non-pitting leg edema.<br /><br />Workup revealed marked leukocytosis with severe eosinophilia (absolute eosinophil count 17,800 cells/L), elevated troponin, bilateral lower-extremity deep vein thromboses, and MRI evidence of multiple bilateral supratentorial and cerebellar infarcts. Bone marrow biopsy was unremarkable, and infectious, rheumatologic, atopic, and neoplastic evaluations were negative.<br /><br />The findings supported idiopathic hypereosinophilic syndrome (HES), defined by persistent hypereosinophilia with eosinophil-mediated organ damage without another identified cause. The report notes that HES commonly affects the skin, lungs, and gastrointestinal tract, but can also involve the heart and nervous system. Proposed mechanisms include inflammatory cytokine release, oxidative injury, endothelial damage, and activation of the clotting cascade.<br /><br />The patient was treated with high-dose intravenous steroids, therapeutic anticoagulation, aspirin, and atorvastatin. Her eosinophil count normalized, and her visual symptoms and ulnar neuropathy improved. She was discharged on prednisone and hydroxyurea with hematology and allergy follow-up.<br /><br />The key lesson is that clinicians should maintain a high index of suspicion for HES in patients with unexplained hypereosinophilia, since delayed diagnosis and treatment can lead to serious thrombotic events and multi-organ failure.

Asset Subtitle

Katie E. Raffel

Meta Tag

Author List Jacqueline Urban, Jason Persoff, Katie E. Raffel, Maria Klimenko, Vivek Patel

Category Clinical Vignettes

Concept Hypereosinophilic Syndrome

Concept Eosinophilia

Concept Organ damage

Concept Corticosteroids

Concept Alternative Cause

Distinguished Non-Finalist

Presenter Organization University of Colorado Anschutz

Presenting Author Katie E. Raffel

Track Adult

Keywords

hypereosinophilic syndrome

eosinophilia

thrombosis

stroke

deep vein thrombosis

troponin elevation

visual acuity loss

ulnar neuropathy

corticosteroids

multi-organ damage

Hypereosinophilic Syndrome

Eosinophilia

Organ damage

Corticosteroids

Alternative Cause