9/13 Tuesday case presentation with JLo: Hypereosinophilic syndrome

An elderly man who initially presented with 10 days of loose stools and abdominal cramping and no red flags symptoms.  He represented a week later with weight loss, diffuse itching and rash.  A CBC was significant for eosinophilia, and through further workup he was diagnosed with hypereosinophilic syndrome

Learning Points

-DDx of diarrhea -> secretory/osmotic, inflammatory, malabsorptive

-Practical tip on differentiating osmotic vs. secretory causes of diarrhea: osmotic diarrhea will cease with fasting

-Hypereosinophilic syndromes (HES) are disorders marked by the sustained overproduction of eosinophils, associated with damage to one or more organs due to eosinophilic infiltration and mediator release

-Hypereosinophilic conditions can be restricted to one organ and overlap of hypereosinophilic conditions can exist – eosinophilic GI disorders, chronic eosinophilic pneumonia, and Well’s syndrome [dermatologic involvement]

-The following organs can be involved: dermatologic (37%), pulmonary (25%), gastrointestinal (14%), cardiac (5%), and neurologic (4%)

-Oncologic workup for HES includes bone marrow aspiration/biopsy – looking for a > 20 % of eosinophils in addition to specialized studies to ID patients with myeloproliferative or clonal lymphocytic variants

-HES is treated with steroids


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