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Idiopathic hypereosinophilic syndrome presenting as cardiac tamponade and multiorgan dysfunction
  1. Kelly Roth1,
  2. Sushan Gupta1,
  3. Vishesh Paul2 and
  4. Priyank Patel3
  1. 1Internal Medicine, Carle Foundation Hospital, Urbana, Illinois, USA
  2. 2Pulmonary and critical care medicine, Carle Foundation Hospital, Urbana, Illinois, USA
  3. 3Hematology & Oncology, Carle Foundation Hospital, Urbana, Illinois, USA
  1. Correspondence to Dr Sushan Gupta; sushangupta{at}


Idiopathic hypereosinophilic syndrome is characterised by the overproduction of eosinophils with tissue infiltration, leading to multiorgan dysfunction. Its heterogenous presentation makes the diagnosis challenging and easy to miss. A woman in her 70s was admitted with chest pain and shortness of breath. Diagnostic testing showed elevated cardiac enzymes, an ejection fraction of 45% and pericardial effusion. Pericardiocentesis helped her symptoms significantly. Cardiac catheterisation revealed patent coronary arteries. She was diagnosed with myopericarditis and discharged on non-steroidal anti-inflammatory drugs. She returned the following week with worsening chest pain, dyspnoea and diarrhoea. Chest imaging showed bilateral infiltrates. Diagnostic testing showed eosinophilic predominance in peripheral blood (59%), pericardial fluid (37%) and bronchoalveolar lavage (31%). After a negative infectious workup, she was started on glucocorticoids and responded favourably. She was discharged on steroids. Mepolizumab was initiated outpatient, and steroids were discontinued. Mepolizumab was discontinued after 2 years while monitoring her symptoms and eosinophil counts.

  • Respiratory medicine
  • Pneumonia (respiratory medicine)
  • Intensive care
  • Pericardial disease
  • Immunological products and vaccines

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  • Contributors KR, SG, VP, PP were responsible for drafting of the text, sourcing and editing of clinical images, investigation results, drawing original diagrams and algorithms, and critical revision for important intellectual content. KR, SG, VP, PP gave final approval of the manuscript.

  • 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.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

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