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Cyclic eosinophilic myositis and hyperimmunoglobulin-E.

W A Symmans, C H Beresford, D Bruton

    Annals of Internal Medicine
    |January 1, 1986
    PubMed
    Summary
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    This study details a unique cyclic syndrome in a 40-year-old man characterized by weight gain, eosinophilic myositis, high immunoglobulin E (IgE), and hypereosinophilia. Prednisone therapy effectively managed these recurrent episodes, suggesting a potential treatment for this rare condition.

    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.

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  • 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.