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Hypereosinophilia with systemic thrombophlebitis
Hiroyuki Kanno1, Naohisa Ouchi, Masatoshi Sato
1Department of Pathology, Iwate Medical University School of Medicine, Morioka, Japan. hirokan@iwate-med.ac.jp
Human Pathology
|June 11, 2005
Summary
A rare case of extreme eosinophilia led to fatal brain infarction and systemic thrombophlebitis, resembling hypereosinophilic syndrome (HES) but not meeting diagnostic criteria.
Area of Science:
- Pathology
- Hematology
- Immunology
Background:
- Hypereosinophilic syndrome (HES) is a group of disorders characterized by persistent eosinophilia.
- Vascular involvement in HES typically includes arterial occlusions and inflammation.
- Diagnostic criteria for HES and Churg-Strauss syndrome were not met in this patient.
Observation:
- A 34-year-old woman presented with subcutaneous induration, extreme eosinophilia, and neurological symptoms.
- Autopsy revealed endocarditis with eosinophil infiltration and widespread thrombophlebitis, affecting pulmonary and portal veins.
- Arterial structures were notably preserved, distinguishing it from typical HES vascular manifestations.
Findings:
- The patient died from hemorrhagic brain infarction secondary to extreme eosinophilia.
- Postmortem serology confirmed anti-Ascaris IgE antibodies.
- Systemic thrombophlebitis without arterial lesions in hypereosinophilia is a novel observation.
Implications:
- This case expands the understanding of vascular pathology in hypereosinophilic conditions.
- It suggests that thrombophlebitis, particularly venous, can be a significant manifestation of HES-like disorders.
- Further research is needed to elucidate the mechanisms of venous thrombosis in hypereosinophilia.