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Case Report
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| Eosinophilic syndrome with life-threatening end-organ damage | ||||||
| Shahd Ahmed1, Erini V Kasfiki2, John Smith3 | ||||||
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1Department of acute medicine, Scarborough hospital, Yorkshire and Humber Deanery.
2Department of Respiratory Medicine, Scarborough Hospital, Yorkshire and Humber Deanery. 3Department of Acute Medicine, Harrogate Hospital, Harrogate, Yorkshire, UK. | ||||||
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| How to cite this article |
| Ahmed S, Kasfiki EV, Smith J. Eosinophilic syndrome with life-threatening end-organ damage. Int J Case Rep Imag 2016;7(4):212–215. |
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Abstract
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Introduction:
Hypereosinophilic syndrome (HES) can be a multisystem disorder due to direct end-organ damage by eosinophilia, and can rarely present with life-threatening features.
We present a case of multi-organ failure secondary to eosinophilia related to medications.
Case Report: A 66-year-old woman with a recent diagnosis of asthma on montelukast, presented with excruciating pains of sudden onset in her lower limbs, and on admission, she was found to be in multi-organ failure. After initial resuscitation, immunological investigations, including vasculitic screen were negative, and hematological investigations revealed severe eosinophilia. She was diagnosed to have systemic eosinophilic granulomatosis polyarteritis secondary to montelukast. The agent was withdrawn and the patient was started on prednisolone. The initial symptom of severe pains preventing her from mobilizing was reversed within days and the patient was cured and become steroid free after six weeks of steroid treatment with no further problems reported in subsequent follow-up. Conclusion: Case report: A 66-year-old woman with a recent diagnosis of asthma on montelukast, presented with excruciating pains of sudden onset in her lower limbs, and on admission, she was found to be in multi-organ failure. After initial resuscitation, immunological investigations, including vasculitic screen were negative, and hematological investigations revealed severe eosinophilia. She was diagnosed to have systemic eosinophilic granulomatosis polyarteritis secondary to montelukast. The agent was withdrawn and the patient was started on prednisolone. The initial symptom of severe pains preventing her from mobilizing was reversed within days and the patient was cured and become steroid free after six weeks of steroid treatment with no further problems reported in subsequent follow-up. Conclusion: Eosinophilia may have a variety of causes, and montelukast is a recognized agent that can give rise to an eosinophilic syndrome. It can only be diagnosed once other systemic disorders have been excluded. The presentation can vary and can be multisystem, and rarely life-threatening, but it potentially is completely reversible, depending on the underlying diagnosis. In case of medications causing the syndrome, stopping the agent and giving a course of steroids may reverse the condition as in this case, without the need of immunotherapy in the long-term. | |
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Keywords:
End-organ damage, Eosinophilia, Hypereosinophilic syndrome, Life-threatening vasculitis
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Author Contributions
Shahd Ahmed – Group 1- Substantial contribution to conception and design, and acquisition of data, Group 2- Drafting the article, revising the article, Group 3- Final approval for publication Eirini Kasfiki – Group 1- Substantial contribution to conception and design, and acquisition of data, Group 2- Drafting the article, revising the article, Group 3- Final approval for publication John Smith – Group 1- Substantial contribution to conception and design, and acquisition of data, Group 2- Drafting the article, revising the article, Group 3- Final approval for publication |
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Guarantor of submission
The corresponding author is the guarantor of submission. |
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Source of support
None |
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Conflict of interest
Authors declare no conflict of interest. |
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Copyright
© 2016 Shahd Ahmed et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information. |
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