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Missed hypereosinophilic syndrome in a critically ill patient with systemic lupus erythematosus
  1. Ying Ling1,
  2. Mary Jane Bell2,3,
  3. Lisa Chodirker1,4 and
  4. Shirley Lake2,3
  1. 1Division of Hematology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
  2. 2Division of Rheumatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
  3. 3Division of Rheumatology, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
  4. 4Division of Hematology, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
  1. Correspondence to Dr Ying Ling; ying.ling{at}one-mail.on.ca

Abstract

A high functioning 74-year-old man with systemic lupus erythematosus presented to the emergency department with acute anxiety. He was found to have elevated cardiac enzymes and admitted to the cardiology service for investigation. In hospital, he developed an erythematous papular rash, and deteriorated to being somnolent and bedridden. He was found to have new multiterritory ischaemic strokes. It was eventually noted that he had persistent eosinophilia, present even on admission, which had been overlooked as the total leucocyte count was normal. Serology for antiphospholipid antibody syndrome (APS) was positive. He was diagnosed with hypereosinophilic syndrome (HES) secondary to new APS, and responded to high-dose steroids. This case highlights the importance of fully evaluating a leucocyte differential to make a diagnosis of HES. We discuss the definition, clinical manifestations, diagnostic approach and management of this important condition.

  • systemic lupus erythematosus
  • haematology (incl blood transfusion)
  • stroke

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Footnotes

  • Contributors YL performed data collection, analysis and manuscript preparation. MJB, LC and SL performed data collection, analysis and manuscript editing.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.