SHM Converge Scientific Abstract ePoster Gallery-Don't Ignore the Differential

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This case describes a 29-year-old woman with 3 days of fever, chills, dyspnea, cough, nausea, headaches, night sweats, and myalgias, plus a 3-year history of intermittent dyspnea and fatigue. Initial evaluation showed marked leukocytosis with extreme eosinophilia, anemia, thrombocytosis, and elevated alkaline phosphatase. CT angiography demonstrated diffuse bilateral ground-glass opacities with peripheral nodularity, raising concern for atypical pneumonia.<br /><br />Her differential diagnosis included primary hematologic malignancy, eosinophilic pneumonia, hypereosinophilic syndrome (HES), and parasitic infection. Blood/sputum cultures and broad infectious and rheumatologic testing were obtained. She underwent bronchoscopy and bone marrow biopsy; BAL showed mostly neutrophils with few eosinophils, and bone marrow and molecular studies were negative for malignancy. She was started on prednisone and ivermectin, which was later stopped after Strongyloides serology was negative.<br /><br />Important social and exposure history ultimately clarified the diagnosis: she lived with dogs, cats, a pig, and parakeets; her mother revealed long-standing soil ingestion; and she had prior travel to El Salvador and Jamaica. Serology for Toxocara canis was positive, and no cysts were seen in the liver or lungs to suggest Echinococcus. Her clinical picture was therefore consistent with toxocariasis causing secondary HES.<br /><br />She was treated with albendazole 400 mg twice daily for 5 days and discharged with a prednisone taper. By discharge, her WBC and eosinophil counts had normalized. The case emphasizes that a careful differential and detailed exposure history are essential in patients with hypereosinophilia, as parasitic infection can mimic hematologic disease and other pulmonary syndromes.

Asset Subtitle

Devicka Ojha

Meta Tag

Author List Devicka Ojha

Category Clinical Vignettes

Concept Idiopathic Hypereosinophilic Syndrome

Concept Hypereosinophilia

Concept End-organ Dysfunction

Concept Parasitic infection

Concept Absolute Eosinophil Count

Distinguished Non-Finalist

Presenter Organization The Ohio State Wexner Medical Center

Presenting Author Devicka Ojha

Track Adult

Keywords

hypereosinophilia

toxocariasis

eosinophilia

ground-glass opacities

hypereosinophilic syndrome

albendazole

prednisone

parasitic infection

pulmonary infiltrates

Toxocara canis

Idiopathic Hypereosinophilic Syndrome

Hypereosinophilia

End-organ Dysfunction

Parasitic infection

Absolute Eosinophil Count