SHM Converge Scientific Abstract ePoster Gallery-Eosin Loving: A Misleading Presentation of a Refractory Hypereosinophilic Syndrome

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This case describes a 46-year-old woman with asthma and rheumatoid arthritis who initially presented with chest pain, later developed altered mental status and vomiting, and was found to have rapidly progressive hypereosinophilia. Her absolute eosinophil count rose from 1.76 to 41, and she developed multisystem involvement including embolic/watershed brain infarcts, pericardial effusion, and cardiac thrombi consistent with Loeffler’s endocarditis. Despite transfer to a tertiary center and treatment with high-dose steroids, hydroxyurea, albendazole, mepolizumab, and broad-spectrum antibiotics, she developed multiorgan failure and died.<br /><br />The authors emphasize that hypereosinophilic syndrome (HES) is rare, severe, and can mimic more common conditions such as acute coronary syndrome, cholecystitis, vasculitis, infection, or drug reaction. The diagnostic workup included infectious studies, imaging, echocardiography, cardiac MRI, skin biopsy, bone marrow biopsy, and cytogenetic testing. Findings supported eosinophilic disease with thrombotic, rather than vasculitic, injury.<br /><br />Key differentials considered were eosinophilic granulomatosis with polyangiitis (EGPA), myeloproliferative/neoplastic disease, helminth infection, and drug-induced eosinophilia. EGPA was felt unlikely because there was no clear small-vessel vasculitis, eosinophilia persisted despite steroids, and skin biopsy showed thrombotic vasculopathy without vasculitis. Myeloproliferative causes were not supported by bone marrow and molecular testing (including JAK2, FGFR1, PDGFRB, FLT3). Strongyloides serology was positive, but endoscopic and stool evaluation did not confirm active infection, and drug hypersensitivity was also considered less likely.<br /><br />Ultimately, the diagnosis was idiopathic hypereosinophilic syndrome. The report highlights the importance of early recognition, broad differential diagnosis, and aggressive evaluation in patients with unexplained eosinophilia and organ dysfunction.

Asset Subtitle

Gilmer Rodriguez

Meta Tag

Author List Divya Singh, Gilmer Rodriguez, Jannel Liu, Lourdes Rodriguez

Category Clinical Vignettes

Concept Idiopathic Hypereosinophilic Syndrome

Concept Hypereosinophilia

Concept Eosinophilia

Concept Organ Complications

Concept Cardiac Involvement

Distinguished Non-Finalist

Presenter Organization University of Chicago Medicine

Presenting Author Gilmer Rodriguez

Track Adult

Keywords

hypereosinophilic syndrome

Loeffler endocarditis

eosinophilia

embolic brain infarcts

cardiac thrombi

multisystem involvement

rheumatoid arthritis

asthma

EGPA differential

thrombotic vasculopathy

Idiopathic Hypereosinophilic Syndrome

Hypereosinophilia

Eosinophilia

Organ Complications

Cardiac Involvement