Hypereosinophilic syndrome associated with multiple thromboses requiring ICU admission: A case report.

##plugins.themes.academic_pro.article.sidebar##

Published Nov 18, 2023
Download
pdf
Vol. 101 No. 10 (2023): Tunis med oct 2023

##plugins.themes.academic_pro.article.main##

Islem Ouanes
Intensive Care Unit, Clinique El Yosr Internationale ,Sousse, Tunisia
Sarra Toumi
Intensive Care Unit, Clinique El Yosr Internationale ,Sousse, Tunisia
Yasser Ben Cheikh
Intensive Care Unit, Clinique El Yosr Internationale ,Sousse, Tunisia
Oussama Ben Rejeb
Intensive Care Unit, Clinique El Yosr Internationale ,Sousse, Tunisia
Nadia Mama
Intensive Care Unit, Clinique El Yosr Internationale ,Sousse, Tunisia

Abstract

Hypereosinophilic syndrome (HES) is a leucoproliferative disorder, characterized by marked blood eosinophilia and organ damage due to tissue eosinophilia. Pulmonary involvement may lead to life-threatening acute respiratory failure and intensive care unit (ICU) admission. Association between eosinophilia and thromboembolism has been previously described. However simultaneous venous and arterial thromboses are less reported. We report a case of a 25-year-old man, admitted to the ICU and developed acute respiratory failure, laboratory tests revealed hyperleukocytosis (39,700 /µL) with high eosinophil count (27393 /µl), Computed tomographic (CT) pulmonary angiography on admission showed a right pulmonary embolism and foci of splenic infarctions. Echocardiography showed a thrombus in the ascending aorta. On day 3, the patient presented worsening polypnea with increase of oxygen requirements. Chest CT scan showed pulmonary parenchymal involvement with bilateral condensations surrounded by “tree-in-bud” micronodules. The diagnosis of eosinophilic pneumonia was established.  Bone marrow biopsy showed hyperplasia of the 3 lineages, predominant on the granulocyte lineage made mostly of eosinophilic polynuclear mature cells, suggesting myeloproliferative syndrome. The patient was treated with corticosteroids and anticoagulation. Physicians should consider HES diagnosis in case of hypereosinophilia and evolving life threatening organ damage to avoid therapy delay and complications.

Keywords:

Hypereosinophilic syndrome, myeloproliferative syndrome, Thrombosis, Intensive care unit

##plugins.themes.academic_pro.article.details##

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

References

  1. Shomali W, Gotlib J. World Health Organization-defined eosinophilic disorders: 2022 update on diagnosis, risk stratification, and management. American journal of hematology. 2022;97(1):129-48.
  2. Roufosse FE, Goldman M, Cogan E. Hypereosinophilic syndromes. Orphanet journal of rare diseases. 2007;2:37.
  3. Maino A, Rossio R, Cugno M, Marzano AV, Tedeschi A. Hypereosinophilic syndrome, Churg-Strauss syndrome and parasitic diseases: possible links between eosinophilia and thrombosis. Current vascular pharmacology. 2012;10(5):670-5.
  4. Ames PR, Aloj G, Gentile F. Eosinophilia and thrombosis in parasitic diseases: an overview. Clinical and applied thrombosis/hemostasis : official journal of the International Academy of Clinical and Applied Thrombosis/Hemostasis. 2011;17(1):33-8.
  5. Silva MS, Ramalho C, Ferreira F, Maia I, Joosten A. Idiopathic Hypereosinophilic Syndrome Presenting With Embolic Stroke. Cureus. 2021;13(11):e19307.
  6. Gaillet A, Bay P, Péju E, Ait-Oufella H, Azoulay E, Benchabane N, et al. Epidemiology, clinical presentation, and outcomes of 620 patients with eosinophilia in the intensive care unit. Intensive care medicine. 2023;49(3):291-301.
  7. Sato Y, Fukunaga T, Hayashi T, Asada Y. Hypereosinophilic syndrome associated with occlusive coronary thrombosis and right ventricular thrombus. Pathology international. 2008;58(2):138-41.
  8. Liu Y, Meng X, Feng J, Zhou X, Zhu H. Hypereosinophilia with Concurrent Venous Thromboembolism: Clinical Features, Potential Risk Factors, and Short-term Outcomes in a Chinese Cohort. Scientific reports. 2020;10(1):8359.
  9. Lippi G, Montagnana M, Salvagno GL, Franchini M, Targher G, Guidi GC. Eosinophilia and first-line coagulation testing. Journal of thrombosis and thrombolysis. 2009;28(1):90-3.
  10. Cugno M, Marzano AV, Lorini M, Carbonelli V, Tedeschi A. Enhanced tissue factor expression by blood eosinophils from patients with hypereosinophilia: a possible link with thrombosis. PloS one. 2014;9(11):e111862.
  11. Aukstuolis K, Cooper JJ, Altman K, Lang A, Ayars AG. Hypereosinophilic syndrome presenting as coagulopathy. Allergy, asthma, and clinical immunology : official journal of the Canadian Society of Allergy and Clinical Immunology. 2022;18(1):25.
  12. Bondue A, Carpentier C, Roufosse F. Hypereosinophilic syndrome: considerations for the cardiologist. Heart (British Cardiac Society). 2022;108(3):164-71.
  13. Grolla E, Dalla Vestra M, Bonanni L, Cutolo A, Rigo F. A Rare Case of Aortic Valve Thrombosis in Patient with Idiopathic Hypereosinophilic Syndrome. Case reports in cardiology. 2015;2015:607107.
  14. Ogbogu PU, Bochner BS, Butterfield JH, Gleich GJ, Huss-Marp J, Kahn JE, et al. Hypereosinophilic syndrome: a multicenter, retrospective analysis of clinical characteristics and response to therapy. The Journal of allergy and clinical immunology. 2009;124(6):1319-25.e3.
  15. Li D, Xu L, Lin D, Jiang S, Feng S, Zhu L. Acute pulmonary embolism and deep vein thrombosis secondary to idiopathic hypereosinophilic syndrome. Respiratory medicine case reports. 2018;25:213-5.
  16. Mukai HY, Ninomiya H, Ohtani K, Nagasawa T, Abe T. Major basic protein binding to thrombomodulin potentially contributes to the thrombosis in patients with eosinophilia. British journal of haematology. 1995;90(4):892-9.
  17. Torrent M, Nogués MV, Boix E. Eosinophil cationic protein (ECP) can bind heparin and other glycosaminoglycans through its RNase active site. Journal of molecular recognition : JMR. 2011;24(1):90-100.
  18. Di Micco P, Scudiero O. Idiopathic Hypereosinophilia and Venous Thromboembolism: Is There a Pathophysiological or Clinical Link? Description of an Intriguing Clinical Case. Journal of blood medicine. 2020;11:73-6.
  19. Leiva O, Baker O, Jenkins A, Brunner AM, Al-Samkari H, Leaf RK, et al. Association of Thrombosis With Hypereosinophilic Syndrome in Patients With Genetic Alterations. JAMA network open. 2021;4(8):e2119812.
  20. Akuthota P, Weller PF. Spectrum of Eosinophilic End-Organ Manifestations. Immunology and allergy clinics of North America. 2015;35(3):403-11.
  21. Roufosse F, Weller PF. Practical approach to the patient with hypereosinophilia. The Journal of allergy and clinical immunology. 2010;126(1):39-44.
  22. Ogbogu PU, Rosing DR, Horne MK, 3rd. Cardiovascular manifestations of hypereosinophilic syndromes. Immunology and allergy clinics of North America. 2007;27(3):457-75.
  23. Gao M, Zhang W, Zhao W, Qin L, Pei F, Zheng Y. Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature. Medicine. 2018;97(11):e0079.
  24. Lin J, Huang X, Zhou W, Zhang S, Sun W, Wang Y, et al. Thrombosis in the portal venous system caused by hypereosinophilic syndrome: A case report. Medicine. 2018;97(48):e13425.
  25. Song XH, Xu T, Zhao GH. Hypereosinophilia with cerebral venous sinus thrombosis and intracerebral hemorrhage: A case report and review of the literature. Heart (British Cardiac Society). 2021;9(28):8571-8.
  26. Hinkle L, Gandhi N, Neal R, Narcisse V, 3rd. Hypereosinophilic syndrome presenting with gastrointestinal manifestations. BMJ case reports. 2023;16(4).
  27. Mahjoub S, Baccouche H, Sahnoun M, Kaabi H, Manai Z, Slama H, et al. [The JAK2 mutation in myeloproliferative disorders: A predictive factor of thrombosis]. La Tunisie medicale. 2015;93(7):474-7.
  28. Grieco DL, Munshi L, Piquilloud L. Personalized noninvasive respiratory support for acute hypoxemic respiratory failure. Intensive care medicine. 2023:1-4.
  29. Fujishima S. Guideline-based management of acute respiratory failure and acute respiratory distress syndrome. Journal of intensive care. 2023;11(1):10.