Cyclic eosinophilic myositis and hyperimmunoglobulin-E.

Area of Science:

• Internal Medicine
• Immunology
• Neurology

Background:

• A 40-year-old male presented with a 9-year history of recurrent episodes involving weight gain and eosinophilic myositis.
• These episodes were consistently associated with elevated immunoglobulin E (IgE) levels and marked hypereosinophilia.

Observation:

• During episodes, body weight increased by up to 10.8%, eosinophil counts reached 41.3 x 10^9 cells/L, and IgE levels peaked at 18,000 IU/mL.
• The clinical and laboratory parameters followed a distinct sequential pattern.
• Parasitic causes were ruled out, and anthelmintic treatments proved ineffective.

Findings:

• Low-dose daily prednisone (10 mg/d) initiated in July 1982 led to an immediate reduction in episode severity.
• Prednisone therapy also progressively lengthened the cycle duration from 35 to 170 days.
• No further episodes occurred after March 1984, with the patient maintained on alternate-day prednisone (12.5 mg).

Implications:

• This case highlights a unique, cyclic syndrome with skeletal muscle as the primary target organ.
• The findings suggest that corticosteroid therapy can effectively manage this apparently benign, self-limiting condition.
• This case contributes to the understanding of rare eosinophilic disorders and their management.