CH Wong, SY Ha, PCY Chong, JS Rosa Duque

Abstract

A 16-year-old Chinese boy presented with multiple tender subcutaneous nodules and erythematous pruritic rashes over bilateral lower limbs. Investigation showed markedly elevated circulating eosinophils (7.35x10⁹/L) and positive lupus anticoagulant. Doppler ultrasound and positron emission tomography scan revealed extensive venous thromboses and arterial insufficiency. The diagnosis of idiopathic hypereosinophilic syndrome with multiple end-organ involvement was established after exclusion of possible infectious, allergic and oncologic causes. Symptoms resolved after treatment that included low-molecular-weight heparin, corticosteroid and azathioprine. Here we describe the variable manifestations of hypereosinophilic syndrome and its associated features.