Published online Jun 26, 2022. doi: 10.12998/wjcc.v10.i18.6325
Peer-review started: February 3, 2022
First decision: March 23, 2022
Revised: March 29, 2022
Accepted: April 30, 2022
Article in press: April 30, 2022
Published online: June 26, 2022
Hypereosinophilic syndrome (HES) is a condition characterized by increased eosinophil proliferation in the bone marrow, as well as tissue eosinophilia, often causing organ damage. The cause of the disease is unknown. Initial symptoms include fatigue, cough, shortness of breath, myalgia, angioedema, fever, and pneumonia. In addition to the respiratory symptoms, damage to the central nervous system can lead to severe seizures. Here, we report a case with pneu
A 94-year-old woman was admitted to our hospital for heart failure and bloody stools. After admission, she also showed symptoms of pneumonia. Non-contrast computed tomography of the chest showed pleural effusion and infiltrative shadows. Lower gastrointestinal endoscopy showed multiple ulcers in the sigmoid colon. Blood analyses showed marked eosinophilia (eosinophils 1760/mm3, total leukocytes 6850/mm3). Initial treatment with furosemide 20 mg/d and prednisolone 25 mg/d relieved these symptoms. However, the patient subsequently experienced localised epileptic seizures characterized by bilateral eyelid twitching and eyes rolling upwards, without generalized convulsions, and respiratory arrest occurred. Electroencephalography showed spikes and waves. Non-contrast magnetic resonance imaging of the brain showed extensive peri
HES symptoms are variable and atypical, and the level and timing of eosinophilia and organ damage are often discordant.
Core Tip: Although there are diagnostic criteria for hypereosinophilic syndrome, the various degrees of organ damage and hypereosinophilia often make diagnosis difficult in clinical practice. In addition, the organ damage and blood changes do not always occur concurrently. Therefore, clinicians must consider many differential diagnoses, especially when patients present with atypical symptoms and disease course. Early initiation of treatment is no less important than an accurate diagnosis, and the balance between the two should be considered according to the patient's condition as well as the level and quality of medical resources available at the hospital.