SHM Converge Scientific Abstract ePoster Gallery-A Case of Hypereosinophilia

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This case describes a 75-year-old woman who presented with acute altered mental status after returning from Puerto Rico. She was found to have marked hypereosinophilia (absolute eosinophil count 3100), leukocytosis, generalized lymphadenopathy, elevated troponins, multifocal cerebral embolic infarcts, and deep venous thrombosis. Cardiac MRI suggested eosinophilic myocarditis. Infectious causes of eosinophilia were ruled out.<br /><br />A bone marrow biopsy showed mild chronic lymphocytic leukemia involvement, eosinophilic hyperplasia, normal eosinophil maturation, and negative genetic studies, making a primary malignant or clonal cause less likely. Her overall presentation was felt to be most consistent with idiopathic hypereosinophilic syndrome (HES) with end-organ damage, including cardiac and neurologic involvement, plus hypercoagulability.<br /><br />She was treated promptly with high-dose methylprednisolone, which led to rapid normalization of the eosinophil count, followed by a steroid taper. Her mental status improved slowly but remained significantly impaired; she was ultimately discharged to a skilled nursing facility for rehabilitation. At follow-up, eosinophils remained normal after prednisone taper, though she still required assistance with activities of daily living.<br /><br />The report emphasizes that hypereosinophilia has many causes, but HES is a rare, potentially life-threatening diagnosis that should be suspected when eosinophilia is accompanied by evidence of organ injury. Early recognition and corticosteroid treatment are critical to limit irreversible damage. Hematology consultation is recommended for further diagnostic evaluation, including genetic testing and assessment for underlying hematologic disease.

Asset Subtitle

Bethany L. Boyle

Meta Tag

Author List Animesh Pardanani, Bethany L. Boyle

Category Clinical Vignettes

Concept Hypereosinophilia

Concept Idiopathic Hypereosinophilic Syndrome

Concept High-Dose Corticosteroid

Concept Multi-organ Damage

Concept Organ Involvement

Distinguished Non-Finalist

Presenter Organization Department of General Internal Medicine, Mayo Clinic

Presenting Author Bethany L. Boyle

Track Adult

Keywords

hypereosinophilia

hypereosinophilic syndrome

eosinophilic myocarditis

cerebral embolic infarcts

deep venous thrombosis

altered mental status

corticosteroid treatment

bone marrow biopsy

lymphadenopathy

eosinophilic hyperplasia

Hypereosinophilia

Idiopathic Hypereosinophilic Syndrome

High-Dose Corticosteroid

Multi-organ Damage

Organ Involvement