Probable idiopathic hypereosinophilic syndrome: A case report of severe multi-organ eosinophilic involvement in a young male presenting with heart failure.
Bryanna SullivanMoreen MattiGene ChoSeoyoon LeeMatthew M NobariPublished in: SAGE open medical case reports (2024)
Hypereosinophilic syndrome (HES) is a disorder characterized by elevated levels of eosinophils, which may be associated with multi-organ involvement depending on severity. The recent diagnostic criteria for idiopathic HES require an elevated absolute eosinophil count (AEC) above 1500 cells/mcL with evidence of tissue damage. We present a case of a 37-year-old male firefighter with a purported history of eosinophilic bronchitis who was referred to the hospital with syncopal episodes and a persistent productive cough. The patient showed an AEC of 4500 cells/mcL on admission associated with high inflammatory markers. Cardiac imaging demonstrated acute myocarditis with heart failure and a reduced ejection fraction. Chest imaging was initially suggestive of community-acquired pneumonia. Workup was negative for a malignant etiology; infectious causes similarly were excluded. After a multidisciplinary evaluation, a diagnosis of idiopathic HES was made and steroids were instituted with rapid resolution of symptoms. Our case illustrates the importance of considering hypereosinophilia as a precipitating factor for acute heart failure in an otherwise healthy adult. An expeditious diagnosis can lead to early initiation of steroids to avoid progression toward multi-organ failure.
Keyphrases
- heart failure
- acute heart failure
- induced apoptosis
- case report
- high resolution
- cell cycle arrest
- community acquired pneumonia
- left ventricular
- oxidative stress
- healthcare
- liver failure
- endoplasmic reticulum stress
- atrial fibrillation
- signaling pathway
- drug induced
- cardiac resynchronization therapy
- early onset
- intensive care unit
- fluorescence imaging
- hepatitis b virus
- cell death
- middle aged
- physical activity