Hypereosinophilic syndrome presenting with multiple organ infiltration and deep venous thrombosis: A case report and literature review

Abstract

Background: Hypereosinophilic syndrome (HES) can be fatal, particularly when eosinophils infiltrate vital organs and/or if extensive thrombosis develops. However there are no standard recommendations for the use of anticoagulant therapy of HES in the setting of thrombosis.

Methods: We herein present a case of a 46-year-old female who presented with marked peripheral eosinophilia with symptoms of multi-organ infiltration and extensive deep venous thrombosis (DVT). In this case, evaluation was carried out before the diagnosis was established, and timely standard-dose corticosteroids combined with a new oral anticoagulant (NOAC) therapy were carried out.

Results: These measures resulted in a rapid response and long-term disease control.

Conclusion: Although there are no data to support which anticoagulant is preferred in this setting, this case indicates that the new oral anticoagulants may play an important role in the treatment of thrombosis in HES.

Figure 1

Abdominal–pelvic-enhanced computed tomography scan showing the thrombosis from inferior vena cava to the left tibial veins.

Figure 2

Abdominal–pelvic computed tomography scan showing multiple low density lesions in the liver and kidney.

Figure 3

Chest computed tomography showing bilateral extensive consolidation at peripheral areas.

Figure 4

Hematoxylin–eosin stain of bone marrow (A) and peripheral blood cell (B), 400×, shows heavy infiltration of eosinophils.

Figure 5

The swelling of left lower extremity that gradually regressed (after 11 days).

Figure 6

Timeline of treatment and changes of platelet and eosinophil counts.