[Eosinophilia and hepatopathy]

Area of Science:

• Internal Medicine
• Infectious Diseases
• Gastroenterology

Background:

• Eosinophilia can indicate allergic, infectious, or neoplastic conditions, ranging from mild to life-threatening.
• Idiopathic hypereosinophilic syndrome (HES) is a diagnosis of exclusion characterized by persistent eosinophilia.
• Strongyloides infection is a parasitic disease that can remain asymptomatic for years.

Observation:

• A 70-year-old patient presented with diffuse abdominal pain, severe eosinophilia, and elevated liver parameters.
• Initial treatment for presumed HES with high-dose methylprednisolone led to rapid normalization of eosinophil counts and liver enzymes.
• Further investigation revealed a positive ELISA test for strongyloidiasis.

Findings:

• Strongyloidiasis was identified as the underlying cause of the patient's severe eosinophilia and symptoms.
• Treatment with mebendazole resulted in successful resolution of the parasitic infection.
• The case underscores the potential for strongyloidiasis to mimic other causes of eosinophilia.

Implications:

• Parasitic infections, particularly strongyloidiasis, should be considered in the differential diagnosis of unexplained eosinophilia, even in the absence of typical symptoms.
• Accurate diagnosis and targeted antiparasitic treatment are crucial for managing eosinophilia secondary to infections.
• This case highlights the importance of a comprehensive diagnostic approach in patients with persistent eosinophilia and gastrointestinal symptoms.