Allergy Asthma Immunol Res.  2014 Jan;6(1):98-101. 10.4168/aair.2014.6.1.98.

A Case of Idiopathic Hypereosinophilic Syndrome Presenting With Acute Respiratory Distress Syndrome

• Lim KS
• Ko J
• Lee SS
• Shin B
• Choi DC
• Lee BJ

• KMID: 2166956
• DOI: http://doi.org/10.4168/aair.2014.6.1.98

Abstract

Although idiopathic hypereosinophilic syndrome(IHES) commonly involves the lung, it is rarely associated with acute respiratory distress syndrome (ARDS). Here we describe a case of IHES presented in conjunction with ARDS. A 37-year-old male visited the emergency department at Samsung Medical Center, Seoul, Korea, with a chief complaint of dyspnea. Blood tests showed profound peripheral eosinophilia and thrombocytopenia. Patchy areas of consolidation with ground-glass opacity were noticed in both lower lung zones on chest radiography. Rapid progression of dyspnea and hypoxia despite supplement of oxygen necessitated the use of mechanical ventilation. Eosinophilic airway inflammation was subsequently confirmed by bronchoalveolar lavage, leading to a diagnosis of IHES. High-dose corticosteroids were administered, resulting in a dramatic clinical response.

Keyword

Idiopathic hypereosinophilic syndrome; eosinophilia; acute respiratory distress syndrome; pulmonary thromboembolism

MeSH Terms

Adrenal Cortex Hormones
Adult
Anoxia
Bronchoalveolar Lavage
Diagnosis
Dyspnea
Emergency Service, Hospital
Eosinophilia
Eosinophils
Hematologic Tests
Humans
Hypereosinophilic Syndrome*
Inflammation
Korea
Lung
Male
Oxygen
Pulmonary Embolism
Radiography
Respiration, Artificial
Respiratory Distress Syndrome, Adult*
Seoul
Thorax
Thrombocytopenia
Adrenal Cortex Hormones
Oxygen

Figure

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  Fig. 1 (A) Patchy areas of consolidation with ground-glass opacity are observed in both lower lung zones on the initial chest radiograph. (B) Follow-up chest radiograph on hospital day 9 shows a dramatic decrease of lung infiltrate. (C) Chest CT scan shows bilateral acute pulmonary thromboembolism (arrows) involving both pulmonary arteries.

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  Fig. 2 Skin biopsy of the purpuric lesions of the right ankle shows (A) diffuse eosinophilic perivascular infiltration in the dermis and (B) eosinophilic abscess in the subcutaneous fat (H&E stain, ×40 magnification).

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  Fig. 3 Platelet counts, eosinophil counts, and D-dimer levels during hospitalization. Following initiation of high-dose corticosteroid therapy, eosinophil counts decreased to normal levels by day 3, and platelet counts progressively recovered. D-dimer levels initially elevated, but began to decrease with anticoagulant therapy. HD, hospital day.

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