SHM Converge Scientific Abstract ePoster Gallery-A "Toxoc" Cause of Hypereosinophilic Syndrome

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This case describes a 76-year-old Somali immigrant with several weeks of progressive dyspnea and wheezing, transferred from an outside hospital after failing treatment for presumed community-acquired pneumonia. He had a marked eosinophilia that rose to 10.1 x10^9/L, prompting evaluation for hypereosinophilic syndrome (HES).<br /><br />His past medical history included ischemic cardiomyopathy, type 2 diabetes, and chronic kidney disease stage 3A. He had previously lived in Somalia, Yemen, and Indonesia, immigrated to Minnesota five years earlier, and reported no recent travel or animal exposure. On exam, he had bilateral expiratory wheezing but was otherwise stable.<br /><br />Workup showed hypereosinophilia with elevated IgE, normal smear and tryptase, and negative testing for autoimmune, hematologic, infectious, and parasitic alternatives including stool ova and parasites, which are typically negative in toxocariasis because humans do not shed eggs. He also had renal and hepatic involvement, with elevated creatinine and liver enzymes. Toxicara serology was positive.<br /><br />The final diagnosis was hypereosinophilic syndrome secondary to toxocariasis, with pulmonary, renal, and hepatic involvement. He was treated with albendazole and inhaled steroids, leading to clinical and laboratory improvement. His dyspnea and wheezing resolved, renal function returned to baseline, liver tests normalized, and eosinophil counts eventually normalized.<br /><br />The case highlights that eosinophilia has a broad differential, but evaluation should focus on identifying the cause and assessing end-organ damage. In developed countries, medications are the most common cause, while parasitic infections are common worldwide. Toxocariasis should be considered in patients with compatible exposure history and positive serology.

Asset Subtitle

Chris A. Dinh

Meta Tag

Author List Chris A. Dinh, Neel B. Shah

Category Clinical Vignettes

Concept Eosinophilia

Concept Hypereosinophilia

Concept Toxocariasis

Concept Differential Diagnosis

Concept Clinical Evaluation

Distinguished Non-Finalist

Presenter Organization Mayo Clinic

Presenting Author Chris A. Dinh

Track Adult

Keywords

hypereosinophilic syndrome

toxocariasis

eosinophilia

dyspnea

wheezing

albendazole

pulmonary involvement

renal involvement

hepatic involvement

Somali immigrant

Eosinophilia

Hypereosinophilia

Toxocariasis

Differential Diagnosis

Clinical Evaluation