SHM Converge Scientific Abstract ePoster Gallery-Pleural Fluid Eosinophilia: A Rare Manifestation of Hypereosinophilic Syndrome

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This case report describes a 65-year-old woman who presented with two months of worsening dyspnea, orthopnea, cough, hypoxia, and bilateral pleural effusions. Initial findings included leukocytosis with marked peripheral eosinophilia (AEC 3.9 K/uL), exudative eosinophilic pleural fluid, and imaging suggestive of fluid overload and possible pneumonia. She was treated initially for infection and heart failure, but CT chest and cardiac MRI ruled out malignancy, pleural/lung lesions, and myocardial infiltration.<br /><br />After discharge, she was readmitted one week later with acute hypoxic respiratory failure and worsening eosinophilia (AEC 7.8 K/uL). Because eosinophilia had persisted for more than two months, a broader workup for hypereosinophilic syndrome (HES) was performed. Evaluation showed elevated IgE, normal tryptase, unremarkable infectious and autoimmune testing, negative molecular studies (including BCR-ABL, PDGFR α/β, and FGFR), and bone marrow biopsy demonstrating hypercellular marrow with eosinophilia. These findings supported a diagnosis of idiopathic acquired HES by exclusion.<br /><br />She improved rapidly after intravenous corticosteroids, with a sharp decline in eosinophil count and clinical stabilization, and was discharged on prednisone.<br /><br />The report highlights that eosinophilic pleural effusion is uncommon and represents a rare manifestation of HES. It emphasizes the importance of considering HES in patients with eosinophilic pleural effusion after common causes such as infection, autoimmune disease, malignancy, and drug reactions have been excluded. Timely recognition is important because corticosteroid therapy can lead to rapid improvement.

Asset Subtitle

Chilsia Shafi

Meta Tag

Author List Arooj Quadir, Chilsia Shafi, Kristina Tanovic, Lekha Yadukumar, Shams Tasnim

Category Clinical Vignettes

Concept Hypereosinophilic Syndrome

Concept Peripheral Eosinophilia

Concept End-Organ Involvement

Concept Eosinophilic Pleural Fluid

Concept Pleural Effusion

Distinguished Non-Finalist

Presenter Organization The Wright Center for Graduate Medical Education

Presenting Author Chilsia Shafi

Track Adult

Keywords

hypereosinophilic syndrome

eosinophilic pleural effusion

peripheral eosinophilia

bilateral pleural effusions

dyspnea

corticosteroid therapy

idiopathic HES

exudative effusion

acute hypoxic respiratory failure

bone marrow biopsy

Hypereosinophilic Syndrome

Peripheral Eosinophilia

End-Organ Involvement

Eosinophilic Pleural Fluid

Pleural Effusion