[Icterus disclosing pancreatic involvement in idiopathic hypereosinophilic syndrome]

We report herein what we think is the first case of an idiopathic hypereosinophilic syndrome in which jaundice (caused by eosinophilic pancreatitis) was the first major symptom. The duodenum and an antral polyp were also infiltrated by eosinophils. In our case, diagnosis was based upon the classic three fold criteria: a) persistent eosinophilia (greater than or equal to 1,500/mm3, b) lack of evidence for any other recognized cause of eosinophilia, c) multiple organ systemic involvement: skin, lymph nodes, heart (detected by routine echocardiography), nerves (discovered on electromyography), and later, arthritis and pleural effusion. Biological signs included increased plasmatic IgE levels (3,500 UI/ml), circulating immune complexes and absence of leukemic markers. This case emphasizes the difficulty in classifying eosinophilic infiltrations of the gut and the possibility of transitional forms between eosinophilic granuloma, eosinophilic gastroenteritis and the hypereosinophilic syndrome.