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

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.