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Spina E, Maniscalco GT, Petraroli A, Detoraki A, Servillo G, Ranieri A, De Mase A, Renna R, Candelaresi P, De Paulis A, Andreone V. An unusual neurological presentation in a patient with primary hypereosinophilic syndrome. J Stroke Cerebrovasc Dis 2022; 31:106703. [PMID: 36075130 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 08/01/2022] [Accepted: 08/03/2022] [Indexed: 11/29/2022] Open
Abstract
Hypereosinophilic syndromes are characterized by an increased number of blood eosinophils (usually more than 1.5 × 109) infiltrating tissues and causing organ damage through over-production of pro-inflammatory cytokines with heterogeneous clinical presentation. Here we present a case of a 47 years old male, with an unremarkable previous medical history, with a sudden onset of subungual hemorrhage and low back pain. Admitted for right arm weakness and vomiting, was raised the suspicion of acute cerebrovascular syndrome, but a brain CT scan with angiogram and perfusion sequences did not show any signs of early ischaemic lesions; conversely, lab tests revealed an increased peripheral eosinophil blood count. Clinical conditions rapidly worsened and a brain MRI showed multiple sub-acute ischaemic lesions compatible with vasculitis while EEG was in favor of widespread cortical distress. Diagnosis of the hypereosinophilic syndrome was made through peripheral blood smear and osteo-medullar biopsy, which showed a rich prevalence of eosinophils. The molecular biology testing showed FIP1L1-PDGRA gene mutation. Despite the prompt therapy beginning with intravenous corticosteroids and tyrosine-kinase inhibitors with normalization of cell blood count in a few days, the patient remained in minimal consciousness. When facing unusual symptoms onset (low back pain with weakness in one limb) and a highly impaired WBC not consistent with other courses (such as infections, vasculitis, allergies, and other diseases involving the immune system) clinicians should take into account the possibility of a hematological disorder and treat it as soon as possible to avoid a poor prognosis.
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Affiliation(s)
- E Spina
- Neurology and Stroke Unit, AORN "A. Cardarelli", Naples, Italy; Department of Neuroscience, Reproductive Science and Odontostomatology, Federico II University, Naples, Italy.
| | - G T Maniscalco
- Neurology and Stroke Unit, AORN "A. Cardarelli", Naples, Italy.
| | - A Petraroli
- Internal Medicine and Immunology, Federico II University, Naples.
| | - A Detoraki
- Internal Medicine and Immunology, Federico II University, Naples.
| | - G Servillo
- Neurology and Stroke Unit, AORN "A. Cardarelli", Naples, Italy.
| | - A Ranieri
- Neurology and Stroke Unit, AORN "A. Cardarelli", Naples, Italy.
| | - A De Mase
- Neurology and Stroke Unit, AORN "A. Cardarelli", Naples, Italy.
| | - R Renna
- Neurology and Stroke Unit, AORN "A. Cardarelli", Naples, Italy.
| | - P Candelaresi
- Neurology and Stroke Unit, AORN "A. Cardarelli", Naples, Italy
| | - A De Paulis
- Internal Medicine and Immunology, Federico II University, Naples.
| | - V Andreone
- Neurology and Stroke Unit, AORN "A. Cardarelli", Naples, Italy.
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