1
|
Diny NL, Wood MK, Won T, Talor MV, Lukban C, Bedja D, Wang N, Kalinoski H, Daoud A, Talbot CC, Leei Lin B, Čiháková D. Hypereosinophilia causes progressive cardiac pathologies in mice. iScience 2023; 26:107990. [PMID: 37829205 PMCID: PMC10565781 DOI: 10.1016/j.isci.2023.107990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 08/02/2023] [Accepted: 09/16/2023] [Indexed: 10/14/2023] Open
Abstract
Hypereosinophilic syndrome is a progressive disease with extensive eosinophilia that results in organ damage. Cardiac pathologies are the main reason for its high mortality rate. A better understanding of the mechanisms of eosinophil-mediated tissue damage would benefit therapeutic development. Here, we describe the cardiac pathologies that developed in a mouse model of hypereosinophilic syndrome. These IL-5 transgenic mice exhibited decreased left ventricular function at a young age which worsened with age. Mechanistically, we demonstrated infiltration of activated eosinophils into the heart tissue that led to an inflammatory environment. Gene expression signatures showed tissue damage as well as repair and remodeling processes. Cardiomyocytes from IL-5Tg mice exhibited significantly reduced contractility relative to wild type (WT) controls. This impairment may result from the inflammatory stress experienced by the cardiomyocytes and suggest that dysregulation of contractility and Ca2+ reuptake in cardiomyocytes contributes to cardiac dysfunction at the whole organ level in hypereosinophilic mice.
Collapse
Affiliation(s)
- Nicola Laura Diny
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Megan Kay Wood
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Taejoon Won
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Monica Vladut Talor
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Clarisse Lukban
- Department of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Djahida Bedja
- Department of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Nadan Wang
- Department of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Hannah Kalinoski
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Abdel Daoud
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD 21205, USA
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - C. Conover Talbot
- Institute for Basic Biomedical Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Brian Leei Lin
- Department of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Daniela Čiháková
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD 21205, USA
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| |
Collapse
|
2
|
Khoury P, Akuthota P, Kwon N, Steinfeld J, Roufosse F. HES and EGPA: Two Sides of the Same Coin. Mayo Clin Proc 2023; 98:1054-1070. [PMID: 37419574 DOI: 10.1016/j.mayocp.2023.02.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 02/03/2023] [Accepted: 02/15/2023] [Indexed: 07/09/2023]
Abstract
Elevated eosinophil counts are implicated in multiple diseases, from relatively prevalent organ-specific disorders such as severe eosinophilic asthma, to rare multisystem disorders such as hypereosinophilic syndrome (HES) and eosinophilic granulomatosis with polyangiitis (EGPA). Patients with these multisystem diseases, often associated with markedly elevated eosinophil counts, have a substantial risk of morbidity and mortality due to delayed diagnosis or inadequate treatment. A thorough workup of symptomatic patients presenting with elevated eosinophil counts is essential, although in some cases the differential diagnosis may remain difficult because of overlapping presentations between HES and EGPA. Notably, first- and second-line treatment options and response to therapy may differ for specific HES and EGPA variants. Oral corticosteroids are the first line of treatment for HES and EGPA, except when HES is the result of specific mutations driving clonal eosinophilia that are amenable to targeted treatment with a kinase inhibitor. Cytotoxic or immunomodulatory agents may be required for those with severe disease. Novel eosinophil-depleting therapies, such as those targeting interleukin 5 or its receptor, have shown great promise in reducing blood eosinophil counts, and reducing disease flares and relapses in patients with HES and EGPA. Such therapies could reduce the side effects associated with long-term oral corticosteroids or immunosuppressant use. This review provides a pragmatic guide to approaching the diagnosis and clinical management of patients with systemic hypereosinophilic disorders. We highlight practical considerations for clinicians and present cases from real-world clinical practice to show the complexity and challenges associated with diagnosing and treating patients with HES and EGPA.
Collapse
Affiliation(s)
- Paneez Khoury
- Eosinophil Clinical Research Unit, LPD, National Institute of Health, Bethesda, MD, USA
| | | | - Namhee Kwon
- Respiratory Research & Development, GSK, GSK House, Brentford, Middlesex, UK
| | | | - Florence Roufosse
- Department of Internal Medicine, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium.
| |
Collapse
|
3
|
Zheng HT, Xu Y, Yan XY, Yan YB, Ma SX, Liu LL, Zhao QY. Pediatric hypereosinophilic syndrome associated with liver damage, portal vein, splenic vein and superior mesenteric vein thromboses: a case report. BMC Pediatr 2023; 23:233. [PMID: 37173706 PMCID: PMC10176765 DOI: 10.1186/s12887-023-04014-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 04/15/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND The hypereosinophilic syndrome (HES) is a group of rare blood disorders characterized by persistent eosinophilia and damage to multiple organs. HES can be either primary, secondary or idiopathic. Secondary HES are commonly caused by parasitic infections, allergic reactions or cancer. We described a pediatric case of HES associated with liver damage and multiple thrombi. A 12-year-old boy with eosinophilia was complicated with severe thrombocytopenia, liver damage, portal vein, splenic vein, and superior mesenteric vein thromboses. The thrombi recanalized after treatment with methylprednisolone succinate and low molecular weight heparin. No side effects appeared after 1-month. CONCLUSIONS Corticosteroids should be used at an early stage of HES to prevent further damage to vital organs. Anticoagulants should be recommended only in cases with thrombosis which should be actively screened as a part of evaluation of end organ damage.
Collapse
Affiliation(s)
- Hai-Tao Zheng
- Department of Pediatrics, The First Affiliated Hospital of Henan University of Chinese Medicine, 19 Renmin Road, Zhengzhou, 450003, Henan, China
- Henan University of Chinese Medicine School of Pediatrics, Zhengzhou, China
| | - Yan Xu
- Henan University of Chinese Medicine, Zhengzhou, China
| | - Xiao-Yu Yan
- First Clinical Medical College of Henan University of Chinese Medicine, Zhengzhou, China
| | - Yong-Bin Yan
- Department of Pediatrics, The First Affiliated Hospital of Henan University of Chinese Medicine, 19 Renmin Road, Zhengzhou, 450003, Henan, China
- Henan University of Chinese Medicine School of Pediatrics, Zhengzhou, China
| | - Shu-Xia Ma
- Department of Pediatrics, The First Affiliated Hospital of Henan University of Chinese Medicine, 19 Renmin Road, Zhengzhou, 450003, Henan, China
- Henan University of Chinese Medicine School of Pediatrics, Zhengzhou, China
| | - Ling-Ling Liu
- Department of Pediatrics, The First Affiliated Hospital of Henan University of Chinese Medicine, 19 Renmin Road, Zhengzhou, 450003, Henan, China
- Henan University of Chinese Medicine School of Pediatrics, Zhengzhou, China
| | - Qian-Yi Zhao
- Department of Pediatrics, The First Affiliated Hospital of Henan University of Chinese Medicine, 19 Renmin Road, Zhengzhou, 450003, Henan, China.
- Henan University of Chinese Medicine School of Pediatrics, Zhengzhou, China.
| |
Collapse
|
4
|
Hwee J, Huynh L, Du S, Kwon N, Jakes RW, Alfonso-Cristancho R, Baylis L, Requena G, Khanal A, Rothenberg ME, Sheng Duh M. Hypereosinophilic syndrome in Europe: Retrospective study of treatment patterns, clinical manifestations, and healthcare resource utilization. Ann Allergy Asthma Immunol 2023:S1081-1206(23)00129-1. [PMID: 36863663 DOI: 10.1016/j.anai.2023.02.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 02/20/2023] [Accepted: 02/21/2023] [Indexed: 03/04/2023]
Abstract
BACKGROUND The burden of hypereosinophilic syndrome (HES) in Europe is not well characterized. OBJECTIVE To evaluate real-world patient characteristics, treatment patterns, clinical manifestations, and healthcare resource utilization for patients with HES from France, Germany, Italy, Spain, and the United Kingdom. METHODS In this retrospective, noninterventional study, data for patients with a physician-confirmed diagnosis of HES were abstracted from medical chart reviews. Patients were aged 6 years or older at the time of HES diagnosis and had 1 or more years of follow-up from the index date (first clinic visit between January 2015 and December 2019). Data on treatment patterns, comorbidities, clinical manifestations, clinical outcomes, and healthcare resource utilization were collected from diagnosis or index date to end of follow-up. RESULTS Data for 280 patients were abstracted from medical charts by 121 physicians treating HES, with multiple specialties. Most patients (55%) had idiopathic HES, and 24% had myeloid HES; the median number (interquartile range [IQR]) of diagnostic tests per patient was 10 (6-12). The most common comorbidities were asthma (45%) and anxiety or depression (36%). Most patients (89%) used oral corticosteroids; 64% used immunosuppressants or cytotoxic agents, and 44% used biologics. Patients had a median (IQR) of 3 clinical manifestations (1-5), most commonly constitutional (63%), lung (49%), and skin (48%). Twenty-three percent of patients experienced a flare, and 40% had a complete treatment response. Some patients (30%) were hospitalized with a median (IQR) stay of 9 days (5-15) for HES-related issues. CONCLUSION Patients with HES across 5 European countries had a substantial disease burden despite extensive oral corticosteroids treatment, highlighting the need for additional targeted therapies.
Collapse
Affiliation(s)
| | - Lynn Huynh
- Analysis Group, Inc., Boston, Massachusetts, United States
| | - Shawn Du
- Analysis Group, Inc., Boston, Massachusetts, United States
| | - Namhee Kwon
- Clinical Sciences, Respiratory, GSK, Brentford, Middlesex, United Kingdom
| | | | | | - Lee Baylis
- Global Medical Affairs, GSK, Durham, North Carolina, United States
| | | | - Anamika Khanal
- Analysis Group, Inc., Boston, Massachusetts, United States
| | - Marc E Rothenberg
- Division of Allergy and Immunology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati School of Medicine, Cincinnati, Ohio, United States
| | - Mei Sheng Duh
- Analysis Group, Inc., Boston, Massachusetts, United States
| |
Collapse
|
5
|
Ryan D, Inamullah O, El Husseini N, Wang E, Selim MA, Feng W. The hypereosinophilic syndrome - an unusual cause of myocarditis and cardioembolic strokes. Am J Med Sci 2022; 364:661-668. [PMID: 35609681 DOI: 10.1016/j.amjms.2022.05.019] [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: 06/03/2021] [Revised: 04/22/2022] [Accepted: 05/17/2022] [Indexed: 01/25/2023]
Abstract
Hypereosinophilic syndrome is a rare disorder characterized by excessive peripheral eosinophilia and eosinophil associated end-organ damage. Clinical presentations are heterogenous and can involve skin, pulmonary, cardiac and neurologic dysfunction. Eosinophilic myocarditis is a life-threatening complication that increases the risk of cardiac microemboli, which can subsequently lead to embolic strokes. Secondary to changes in blood viscosity, impaired clearance of microemboli, impaired cerebral blood flow, and pro-thrombotic conditions in the setting of hypereosinophilia, infarcts often present in vascular border zone regions. Here we present two cases of cardioembolic strokes involving borderzone regions in the setting of hypereosinophilic syndrome.
Collapse
Affiliation(s)
- Dylan Ryan
- Department of Neurology, Duke University School of Medicine, Durham, NC 27712, United States.
| | - Ovais Inamullah
- Department of Neurology, Duke University School of Medicine, Durham, NC 27712, United States
| | - Nada El Husseini
- Department of Neurology, Duke University School of Medicine, Durham, NC 27712, United States
| | - Endi Wang
- Department of Pathology, Duke University School of Medicine, Durham, NC 27712, United States
| | - M Angelica Selim
- Department of Pathology, Duke University School of Medicine, Durham, NC 27712, United States
| | - Wuwei Feng
- Department of Neurology, Duke University School of Medicine, Durham, NC 27712, United States
| |
Collapse
|
6
|
Jackson DJ, Akuthota P, Andradas R, Bredenoord AJ, Cordell A, Gray S, Kullman J, Mathur SK, Pavord I, Roufosse F, Rubio C, Rusek IC, Simon D, Strobel MJ, Winders T. Improving Care in Eosinophil-Associated Diseases: A Charter. Adv Ther 2022; 39:2323-2341. [PMID: 35489014 PMCID: PMC9055373 DOI: 10.1007/s12325-022-02110-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 03/02/2022] [Indexed: 11/11/2022]
Abstract
Eosinophil-associated diseases (EADs) are a range of heterogeneous conditions in which eosinophils are believed to play a critical pathological role. EADs include common illnesses such as eosinophilic asthma and chronic rhinosinusitis and rare conditions such as hypereosinophilic syndromes (HES) and eosinophilic gastrointestinal disorders (EGIDs). EADs are associated with substantial burdens for the patient, including chronic, debilitating symptoms, increased financial burden, decreased health-related quality of life, and the need for repeated visits to multiple different healthcare professionals (HCPs), emergency departments, and/or hospitals. Poor EAD recognition by HCPs often contributes to delayed diagnoses, which further delays patient access to appropriate care and effective treatments, contributing to poor health outcomes. The objective of this charter is to outline key patient rights and expectations with respect to the management of their condition(s) and to set forth an ambitious action plan to improve health outcomes for patients with EADs: (1) people with EADs, their caretakers, HCPs, and the public must have greater awareness and education about EADs; (2) people with EADs must receive a timely, accurate diagnosis; (3) all people with EADs must have access to an appropriate multidisciplinary team, when necessary; and (4) people with EADs must have access to safe and effective treatment options without unnecessary regulatory delays. The principles described in this charter demonstrate the core elements of quality care that people with EADs must receive, and they represent clear steps by which to reduce patient and caregiver burden and improve patient outcomes. We urge HCPs, healthcare systems, and policymakers worldwide to swiftly adopt these principles to ensure patients with EADs have an accurate diagnosis in a timely manner and access to high-level care and treatment in an appropriate setting.
Collapse
|
7
|
Neurological Manifestations of Myocarditis. Curr Neurol Neurosci Rep 2022; 22:363-374. [PMID: 35588043 PMCID: PMC9117837 DOI: 10.1007/s11910-022-01203-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE OF REVIEW The present review discusses the neurological complications associated with myocarditis of different etiologies. RECENT FINDINGS Myocarditis can be idiopathic or caused by different conditions, including toxins, infections, or inflammatory diseases. Clinical findings are variable and range from mild self-limited shortness of breath or chest pain to hemodynamic instability which may result in cardiogenic shock and death. Several neurologic manifestations can be seen in association with myocarditis. Tissue remodeling, fibrosis, and myocyte dysfunction can result in heart failure and arrhythmias leading to intracardiac thrombus formation and cardioembolism. In addition, peripheral neuropathies, status epilepticus, or myasthenia gravis have been reported in association with specific types of myocarditis. Multiple studies suggest the increasing risk of neurologic complications in patients with myocarditis. Neurologists should maintain a high suspicion of myocarditis in cases presenting with both cardiovascular and neurological dysfunction without a clear etiology.
Collapse
|
8
|
Jackson DJ, Akuthota P, Roufosse F. Eosinophils and eosinophilic immune dysfunction in health and disease. Eur Respir Rev 2022; 31:31/163/210150. [PMID: 35082127 DOI: 10.1183/16000617.0150-2021] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 10/22/2021] [Indexed: 12/11/2022] Open
Abstract
The functions ascribed to eosinophils have classically been limited to host defence against certain parasitic infections and potentially deleterious effects in the setting of specific diseases that are associated with elevated eosinophil counts in blood and/or tissue. The ability to induce eosinophil depletion either experimentally in animal models or through targeted therapies in humans has extended our understanding of the roles played by eosinophils in health and homeostasis as well as in disease pathogenesis. When associated with human disease aetiology, the eosinophil takes on a pathogenic rather than a protective role. This maladaptive response, called "eosinophilic immune dysfunction" herein, appears central to exacerbation pathogenesis and disease control in severe asthma and may be involved in the aetiology of other eosinophil-related conditions ranging from organ-system-limited diseases such as phenotypic subsets of chronic obstructive pulmonary disease and chronic rhinosinusitis with nasal polyposis to more broadly systemic diseases such as eosinophilic granulomatosis with polyangiitis and hypereosinophilic syndrome. In this review, we describe the evidence supporting eosinophilic functions related to health and homeostasis and explore the contribution of eosinophilic immune dysfunction to human disease.
Collapse
Affiliation(s)
- David J Jackson
- Guy's Severe Asthma Centre, Guy's & St Thomas' NHS Trust, London, UK .,School of Immunology & Microbial Sciences, King's College London, London, UK
| | - Praveen Akuthota
- Division of Pulmonary, Critical Care, and Sleep Medicine, Dept of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Florence Roufosse
- Médecine Interne, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| |
Collapse
|
9
|
Hayama Y, Tomyo F, Ueno M, Asakawa S, Arai S, Yamazaki O, Tamura Y, Mochizuki M, Ohashi R, Shibata S, Fujigaki Y. Renal Involvement as Rare Acute Tubulointerstitial Nephritis in a Patient with Eosinophilic Disorder Treated with Early Add-on Administration of Mepolizumab. Intern Med 2021; 60:3759-3764. [PMID: 34092738 PMCID: PMC8710382 DOI: 10.2169/internalmedicine.7490-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
A 39-year-old man presented with peripheral eosinophilia, pulmonary eosinophilic infiltrate, and renal failure due to acute tubulointerstitial nephritis (TIN). He had experienced childhood asthma and was negative for anti-neutrophil cytoplasmic antibody (ANCA). He was tentatively diagnosed with ANCA-negative eosinophilic granulomatous polyangiitis (EGPA) or idiopathic hypereosinophilic syndrome (HES). Renal involvement of isolated TIN with eosinophil infiltration is rare in EGPA and HES and does not seem to have a good prognosis in the literature. However, his condition improved well with corticosteroids and mepolizumab. The revised classification of EGPA based on the etiology should dictate the proper treatment in suspected EGPA patients with nonsystemic vasculitis.
Collapse
Affiliation(s)
- Yuto Hayama
- Department of Internal Medicine, Teikyo University School of Medicine, Japan
| | - Fuminori Tomyo
- Department of Internal Medicine, Teikyo University School of Medicine, Japan
| | - Masaki Ueno
- Department of Internal Medicine, Teikyo University School of Medicine, Japan
| | - Shinichiro Asakawa
- Department of Internal Medicine, Teikyo University School of Medicine, Japan
| | - Shigeyuki Arai
- Department of Internal Medicine, Teikyo University School of Medicine, Japan
| | - Osamu Yamazaki
- Department of Internal Medicine, Teikyo University School of Medicine, Japan
| | - Yoshifuru Tamura
- Department of Internal Medicine, Teikyo University School of Medicine, Japan
| | - Makoto Mochizuki
- Department of Clinical Laboratory Science, Faculty of Medical Technology, Teikyo University, Japan
| | - Ryuji Ohashi
- Department of Integrated Diagnostic Pathology, Nippon Medical School, Japan
| | - Shigeru Shibata
- Department of Internal Medicine, Teikyo University School of Medicine, Japan
| | - Yoshihide Fujigaki
- Department of Internal Medicine, Teikyo University School of Medicine, Japan
| |
Collapse
|
10
|
Tazi I. Une hyperéosinophilie inexpliquée. Nephrol Ther 2021; 18:151-152. [PMID: 34824044 DOI: 10.1016/j.nephro.2021.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Accepted: 08/17/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Illias Tazi
- Service d'hématologie, faculté de médecine, CHU de Mohamed VI, université Cadi-Ayyad, Marrakech, Maroc.
| |
Collapse
|
11
|
Carcaterra A, Mock S, Müller H, Testuz A. Normalization of left ventricular filling pressure after cardiac surgery for the Loeffler's endocarditis: a case report. EUROPEAN HEART JOURNAL-CASE REPORTS 2021; 5:ytab189. [PMID: 34263118 PMCID: PMC8274654 DOI: 10.1093/ehjcr/ytab189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Revised: 04/15/2020] [Accepted: 03/12/2021] [Indexed: 11/24/2022]
Abstract
Background Loeffler endocarditis is a rare restrictive cardiomyopathy, characterized by hypereosinophilia and fibrous thickening of the endocardium causing progressive onset of heart failure and appearance of thrombi on the walls of the heart chambers. Case summary A 72-year-old man known for hypertension and dyslipidaemia consults for progressive dyspnoea up to New York Heart Association (NYHA) Classes 2–3 over 3 weeks. The biological balance sheet shows a high eosinophil level and an echocardiography shows a mild echodensity fixed to the left apex. After exclusion of a secondary cause of hypereosinophilia, diagnosis of endomyocardial fibrosis in the context of a hypereosinophilic syndrome (HES) is therefore retained. The patient’s clinical presentation with cardiac involvement leads us to start a treatment with corticosteroids. The patient is then regularly followed every 6 months with an initially stable course without complications. Two years later, he develops progressive signs of heart failure. Transthoracic echocardiography shows a left ventricular (LV) dilatation with a normal ejection fraction, but decreased volume due to a large echodense mass in the apex, and moderate aortic regurgitation caused by myocardial infiltration. In view of this rapid evolution, resection of the LV mass with concomitant aortic valve replacement is performed. Pathology confirms eosinophilic infiltration. The clinical course is very good with a patient who remains stable with dyspnoea NYHA Classes 1–2, and echocardiography at 1 year shows a normalization of LV filling pressure. Discussion HES represents a heterogeneous group of disorders characterized by overproduction of eosinophils. One of the major causes of mortality is associated cardiac involvement. Endocardial fibrosis and mural thrombosis are frequent cardiac findings. Echocardiography plays a crucial role in initial diagnosis of endomyocardial fibrosis, and for regular follow-up in order to adapt medical treatment and monitor haemodynamic evolution of the restrictive physiology and of valvular damage caused by the disease’s evolution. This case also shows that surgery can normalize filling pressure and allow a clear improvement on the clinical condition even at the terminal fibrotic state.
Collapse
Affiliation(s)
- Andrea Carcaterra
- Department of Cardiology, University Hospital of Geneva, Rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland
| | - Stéphane Mock
- Department of Cardiology, University Hospital of Geneva, Rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland
| | - Hajo Müller
- Department of Cardiology, University Hospital of Geneva, Rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland
| | - Ariane Testuz
- Department of Cardiology, University Hospital of Geneva, Rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland
| |
Collapse
|
12
|
Ranjbaran R, Abbasi M, Rafiei Dehbidi G, Seyyedi N, Behzad-Behbahani A, Sharifzadeh S. Phosflow assessment of PDGFRA phosphorylation state: A guide for tyrosine kinase inhibitor targeted therapy in hypereosinophilia patients. Cytometry A 2021; 99:784-792. [PMID: 33386673 DOI: 10.1002/cyto.a.24302] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 11/14/2020] [Accepted: 12/28/2020] [Indexed: 11/06/2022]
Abstract
Clonal eosinophilia is a hematologic disorder caused by translocation in growth factor receptor (GFR) genes. Despite the identified molecular mechanisms underlying clonal hypereosinophilia, the distinction between clonal and reactive eosinophilia has remained challenging due to the diversity of partner genes for translocated GFRs. This study aimed to examine the feasibility of phosphoflow cytometry in the diagnosis of clonal hypereosinophilia through evaluating the level of platelet-derived growth factor receptor alpha (PDGFRA) phosphorylation and its correlation with PDGFRA genetic aberration. Blood samples were collected from 45 hypereosinophilia patients and 10 healthy controls. Using phosphoflow cytometry method, the phosphorylation state of PDGFRA was assessed. The specificity of phosflow results was confirmed by western blotting and eventually compared with qRT-PCR expression analysis of 3'-region of PDGFRA. To detect the genetic aberration of PDGFRA, 5'-rapid amplification of cDNA ends (5'-RACE) was performed. Phosflow analysis illustrated that 9 of 45 hypereosinophilic patients had higher level of PDGFRA phosphorylation while sequence analysis of 5'-RACE-PCR fragments confirmed that in seven cases of them, there was a PDGFRA-FIP1L1 fusion. We also verified that two of nine patients with hyperposphorylated PDGFRA hold ETV6-PDGFRA and STRN-PDGFRA rearrangements. Importantly, nine cases also had significantly higher levels of PDGFRA mRNA expression when compared with healthy controls, and cases with no PDGFRA rearrangement. These findings highlight a robust correlation between hyperphosphorylation state of PDGFRA and aberrant PDGFRA gene fusions. This implicates phosflow as an efficient and reliable technique raising an intriguing possibility that it could replace other genomic and cDNA-amplification-based diagnostic approaches with limited effectiveness.
Collapse
Affiliation(s)
- Reza Ranjbaran
- Diagnostic Laboratory Sciences and Technology Research Center, School of Paramedical Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mojdeh Abbasi
- Diagnostic Laboratory Sciences and Technology Research Center, School of Paramedical Sciences, Shiraz University of Medical Sciences, Shiraz, Iran.,Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Gholamreza Rafiei Dehbidi
- Diagnostic Laboratory Sciences and Technology Research Center, School of Paramedical Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Noorossadat Seyyedi
- Diagnostic Laboratory Sciences and Technology Research Center, School of Paramedical Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Abbas Behzad-Behbahani
- Diagnostic Laboratory Sciences and Technology Research Center, School of Paramedical Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sedigheh Sharifzadeh
- Diagnostic Laboratory Sciences and Technology Research Center, School of Paramedical Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| |
Collapse
|
13
|
Farid A, Stauber B, Khamishon S, Fedder D, Fan D. No Loeffing Matter: The Dilemma of Loeffler's Endocarditis. Am J Med 2020; 133:e169-e172. [PMID: 31606491 DOI: 10.1016/j.amjmed.2019.08.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 08/21/2019] [Accepted: 08/22/2019] [Indexed: 10/25/2022]
Affiliation(s)
- Amir Farid
- Division of Cardiovascular Medicine, UC Davis Medical Center, Sacramento, Calif.
| | | | | | - Douglas Fedder
- American University of Antigua, University Park, Coolidge, Antigua
| | - Dali Fan
- Division of Cardiovascular Medicine, UC Davis Medical Center, Sacramento, Calif
| |
Collapse
|
14
|
Costagliola G, Marco SD, Comberiati P, D'Elios S, Petashvili N, Di Cicco ME, Peroni D. Practical Approach to Children Presenting with Eosinophila and Hypereosinophilia. Curr Pediatr Rev 2020; 16:81-88. [PMID: 31729944 DOI: 10.2174/1573396315666191114150438] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 10/08/2019] [Accepted: 10/08/2019] [Indexed: 11/22/2022]
Abstract
Eosinophilia is not a rare finding in clinical practice, and often poses problems in terms of etiologic research and differential diagnosis. Peripheral eosinophilia is defined by a blood eosinophil count > 500 cells/μL. It is classified into mild (500-1500 cells/μl), moderate (1500-5000 cells/μl) and severe for an eosinophil count > 5000 cells /μl. The term "hypereosinophilia" defines a condition characterized by a blood eosinophil count >1500 cells/μl in at least two consecutive tests made with a minimum of a 4-week interval. The causes of eosinophilia are various, and can be summarized by the acronym "APLV" which refers to Allergic disorders, Parasitic infections, Leukemia/ Lymphomas (and solid tumors) and Vasculitis-Immunodeficiency diseases, with allergic disorders and parasitic infections representing the most commonly identified causes. Allergic disorders are usually associated with mild eosinophilia, whereas values >20.000 cell/μl are highly suggestive for myeloproliferative disorders. Eosinophils may also be directly responsible for organ damage, mainly at cardiac, pulmonary and cutaneous level, deriving from the release of the granule products, of lipidic mediators and cytokines. Therefore, in the physician's approach to a patient with persistent hypereosinophilia, it is also important to investigate the presence of organ involvement. In this review, we propose a diagnostic algorithm for children presenting with either blood eosinophilia or hypereosinophilia. This algorithm focuses on the patient's history and clinical manifestations as the first step and the level and persistence of blood eosinophilia as the second, and this can help the physician to identify patients presenting with an elevated blood eosinophil count that need further laboratory or instrumental investigations.
Collapse
Affiliation(s)
- Giorgio Costagliola
- Section of Paediatrics, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
| | - Serena Di Marco
- Section of Paediatrics, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
| | - Pasquale Comberiati
- Section of Paediatrics, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
| | - Sofia D'Elios
- Section of Paediatrics, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
| | | | - Maria Elisa Di Cicco
- Section of Paediatrics, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
| | - Diego Peroni
- Section of Paediatrics, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
| |
Collapse
|
15
|
Blagova OV, Aliyeva IN, Nedostup AV, Kogan EA, Komarov RN, Chernyavsky SV, Seslavinskaya VV, Shelukha PA, Sedov VP, Gagarina NV, Mershina EA, Sinitsyn VE, Fomin VV. Morphologically proved ANCA positive Loeffler's pancarditis: medical and surgical treatment. TERAPEVT ARKH 2019; 91:99-106. [PMID: 31094483 DOI: 10.26442/00403660.2019.04.000048] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Loeffler's endocarditis remains is a very rare disease, develops due to eosinophilic inflammation predominantly of the endocardium with an outcome in fibrosis and massive thrombus formation and. He is generally characterized by an unfavorable prognosis. Clinical case of a 42-year-old patient with Loeffler endocarditis is presented. The development of the disease was preceded by a polyvalent allergy, mild dry eye syndrome and pansinusitis with a single eosinophilia of blood up to 16%. The reason for the hospitalization was the appearance of biventricular heart failure. During the previous year, the level of blood eosinophils remained normal, a threefold increase in the level of eosinophilic cationic protein was observed once. A 20-fold increase in the pANCA level, a 2.5-fold increase in the level of antibodies to DNA, an antibody to the nuclei of cardiomyocytes 1:160 were detected. The diagnosis was made on the basis of electrocardiography data (low QRS voltage, atrial hypertrophy), echocardiography, multispiral computed tomography and magnetic resonance imaging of the heart (thickening and delayed contrasting of the endocardium, massive thrombosis of the left ventricular apex with obliteration of its cavity, encapsulated fluid in the pericardium with compression of the right ventricle). Systolic dysfunction, severe signs of restriction and arrhythmias were absent. Trombectomy, tricuspid valve plasty, pericardial resection, suturing of an open oval window were performed. Signs of active inflammation with single eosinophils, vasculitis, perimuscular sclerosis, endocardial sclerosis were detected in morphological and immunohistochemical studies of endo-, myo-, pericardium. Viral genome was not found. The therapy with methylprednisolone 24 mg/day, azathioprine 75 mg/day was started. Six months after the operation, the symptoms of heart failure are completely absent, the thrombosis did not recur.
Collapse
Affiliation(s)
- O V Blagova
- I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russia
| | - I N Aliyeva
- I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russia
| | - A V Nedostup
- I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russia
| | - E A Kogan
- I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russia
| | - R N Komarov
- I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russia
| | - S V Chernyavsky
- I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russia
| | - V V Seslavinskaya
- I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russia
| | - P A Shelukha
- I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russia
| | - V P Sedov
- I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russia
| | - N V Gagarina
- I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russia
| | - E A Mershina
- Federal Center of Treatment and Rehabilitation of the Ministry of Health of the Russian Federation, Moscow, Russia
| | - V E Sinitsyn
- Federal Center of Treatment and Rehabilitation of the Ministry of Health of the Russian Federation, Moscow, Russia
| | - V V Fomin
- I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russia
| |
Collapse
|
16
|
Hanbali A, Shaheen M, Alfraih F, Al-Otaibi W, El Fakih R, Owaidah T, Ahmed S. A case of T-cell lymphoproliferative disorder associated with hypereosinophilia with excellent response to mycophenolate mofetil. Hematol Oncol Stem Cell Ther 2018; 11:241-244. [DOI: 10.1016/j.hemonc.2016.11.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2016] [Revised: 10/17/2016] [Accepted: 11/14/2016] [Indexed: 11/30/2022] Open
|
17
|
Fatal Outcome of Imatinib in a Patient with Idiopathic Hypereosinophilic Syndrome. Case Rep Oncol Med 2018; 2018:6291614. [PMID: 29780651 PMCID: PMC5892290 DOI: 10.1155/2018/6291614] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 02/05/2018] [Accepted: 02/25/2018] [Indexed: 11/18/2022] Open
Abstract
Cytokine storm is a poorly explained clinical entity caused by an undesired and aggrandized immune system response leading to unregulated activation of the proinflammatory cascade, often contributing to multisystem organ failure and even death. Its potentially diverse etiologies and sepsis-like presentation have made it even more challenging to diagnose, and so far, no well-established treatment protocol has been proposed. Its association with certain medications, especially with monoclonal antibodies, has well been reported in literature. To the best of our knowledge, so far, no previous case of cytokine storm associated with imatinib has been reported. We herein present a case report of a 77-year-old male with a past medical history of hypereosinophilic syndrome who developed acute fatal cytokine storm following treatment with imatinib. This study highlights a life-threatening complication of the medication that may be underrecognized.
Collapse
|
18
|
Dal Berto AS, Camiña RH, Machado ES, Baptistella AR. FIP1L1-PDGFRA fusion-negative hypereosinophilic syndrome with uncommon cardiac involvement responding to imatinib treatment: A case report. Mol Clin Oncol 2018; 9:35-39. [PMID: 29977537 DOI: 10.3892/mco.2018.1637] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 05/21/2018] [Indexed: 12/28/2022] Open
Abstract
Hypereosinophilic syndrome is a rare, chronic hematological disease characterized by a persistently elevated eosinophil count exceeding 1.5×109/l, following the exclusion of other potential etiologies. The systemic involvement of the disease causes tissue damage through eosinophil infiltration, and may affect various organs; cardiac complications are observed in 50-60% of cases, which are predominately attributed to endomyocardial fibrosis. The treatment is based initially on determining the presence of the FIP1L1-PDGFRA fusion. Patients with positive results for this mutation tend to achieve a complete response with imatinib treatment, which is thus the first line of treatment for this condition. However, patients who are negative for this mutation initially undergo treatment with corticosteroids. This study reports the case of a male 53-year-old patient diagnosed with hypereosinophilic syndrome in 2012, with negative results for the FIP1L1-PDGFRA mutation, and persistently high eosinophil levels, despite receiving the second line of standard treatment for this condition with hydroxyurea, and having already used corticosteroids without success. At the time of admission, the patient presented with acute decompensated heart failure due to severe mitral regurgitation, without any evidence of prior myocardial fibrosis or restrictive cardiomyopathy, and without suggestion of an associated ventricular hypertrophy. This clinical presentation is uncommon, as valvular involvement usually appears in the third stage of the development of cardiac involvement, and is usually associated with fibrosis and thrombotic events. Alternative therapeutic possibilities were evaluated due to the significant progression of the disease, and it was decided to attempt the use of imatinib, despite its use being preferably recommended for FIPIL1-PDGFRA-positive patients. The patient exhibited an evident and immediate response to imatinib, with normalization of the eosinophil count within 24 h of the first dose, which was maintained for at least the next 19 months. This clinical presentation is uncommon, as patients negative for FIPIL1-PDGFRA fusion do not frequently respond to imatinib treatment, and symptomatic heart failure usually appears in the third stage of disease progression.
Collapse
Affiliation(s)
| | | | - Eduardo Silva Machado
- Santa Terezinha University Hospital, Joaçaba, Santa Catarina 89600-000, Brazil.,University of West Santa Catarina, Joaçaba, Santa Catarina 89600-000, Brazil.,Department of Clinical Oncology, Santa Terezinha University Hospital, Joaçaba, Santa Catarina 89600-000, Brazil
| | - Antuani Rafael Baptistella
- Santa Terezinha University Hospital, Joaçaba, Santa Catarina 89600-000, Brazil.,University of West Santa Catarina, Joaçaba, Santa Catarina 89600-000, Brazil.,Oncology Research Group of Santa Terezinha University Hospital/University of West Santa Catarina, Joaçaba, Santa Catarina 89600-000, Brazil.,Post Graduation Program in Bioscience and Health/University of West Santa Catarina, Joaçaba, Santa Catarina 89600-000, Brazil
| |
Collapse
|
19
|
Samarghandi A, Ahuja S, Jindal V, Gupta S, Fulger I. Hypereosinophilic syndrome preceding a diagnosis of B-cell lymphoma. TUMORI JOURNAL 2018; 104:NP22-NP24. [PMID: 29714651 DOI: 10.1177/0300891618763211] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Hypereosinophilic syndrome (HES) is a rare condition characterized by eosinophilia and organ destruction secondary to eosinophilic infiltration. The coexistence of primary B-cell lymphoma and hypereosinophilic syndrome is extremely rare. We present a case of HES that preceded the diagnosis of diffuse large B-cell lymphoma. CASE REPORT A 70-year-old man presented with a 3-month history of diarrhea and 30-pound weight loss. Complete blood count showed a white blood cell count of 7452/µL with eosinophils of 42% (absolute eosinophil count 3130). Colonoscopy showed eosinophilic infiltrate in the lamina propria and muscularis mucosa. Bone marrow biopsy showed elevated myeloid: erythroid ratio (6:1), increased mature and immature eosinophilic infiltration (10% of nucleated cells). Molecular studies were negative for Fip1-like1-platelet-derived growth factor receptor alpha (FIP1L1-PDGFRA) translocation and PDGFRB and FGFR mutations, indicating nonclonal eosinophilia. Treatment was initiated with prednisone (1 mg/kg) and hydroxyurea 500 mg twice daily. He responded with complete resolution of symptoms. Five months later, the patient presented with right lower quadrant pain. Abdominal/pelvis computed tomography (CT) showed bulky right inguinal lymphadenopathy and biopsy revealed CD10+ diffuse large B-cell lymphoma (DLBCL). Further staging workup showed the stage to be IIB. He received 6 cycles of chemotherapy and involved field radiation therapy. He achieved complete remission. CONCLUSION Reviewing the literature indicates only one case of similar presentation with concomitant HES and DLBCL. Eosinophilia is routinely encountered in clinical practice and as such physicians must be aware of the rarer, more malevolent underlying associations of this condition so as to aid early diagnosis and prompt treatment.
Collapse
Affiliation(s)
- Arash Samarghandi
- 1 Department of Internal Medicine, St. Barnabas Hospital, Bronx, New York, USA
| | - Shradha Ahuja
- 1 Department of Internal Medicine, St. Barnabas Hospital, Bronx, New York, USA
| | - Vishal Jindal
- 2 Department of Internal Medicine, St. Vincent Hospital, Worcester, Massachusetts, USA
| | - Sorab Gupta
- 1 Department of Internal Medicine, St. Barnabas Hospital, Bronx, New York, USA
| | - Ilmana Fulger
- 3 Department of Hematology and Oncology, St. Barnabas Hospital, Bronx, New York, USA
| |
Collapse
|
20
|
|
21
|
Gao M, Zhang W, Zhao W, Qin L, Pei F, Zheng Y. Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature. Medicine (Baltimore) 2018; 97:e0079. [PMID: 29538200 PMCID: PMC5882404 DOI: 10.1097/md.0000000000010079] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
RATIONALE Hypereosinophilic syndrome (HES) is a rare disease characterized by hypereosinophilia and its ensuing organ damage. Cardiac involvement is divided into 3 chronological stages: an acute necrotic stage; a thrombus formation stage; and a fibrotic stage. Infiltration of the myocardium by eosinophilic cells followed by endomyocardial fibrosis is known as "Loeffler endocarditis." PATIENT CONCERNS We report a case of a 60-year-old man diagnosed with left-sided restrictive cardiomyopathy. DIAGNOSIS The patient experienced heart failure with preserved ejection fraction. The cardiac MRI showed intense, linear, delayed gadolinium enhancement of the endocardium of the lateral wall of the left ventricle, and obliteration of the LV apex. He was ultimately identified as Loeffler endocarditis. INTERVENTION A bone marrow smear and biopsy revealed the FIP1L1-PDGFRA fusion gene was positive in 82% of segmented nucleated cells. OUTCOME Our patient responded well to prednisone at 1 mg/kg/d. LESSONS HES is a rare disease that often afflicts the heart. Cardiac involvement in hypereosinophilia, especially Loeffler endocarditis, carries a poor prognosis and significant mortality. Early detection and treatment of the disease is therefore essential. Further studies are needed to ascertain therapeutic corticosteroid dosages and develop targeted gene therapies, both important steps to ameliorate the effects of Loeffler endocarditis and improve patient outcomes.
Collapse
|
22
|
Hypereosinophilic Syndrome After Liver Transplantation: A Case Report and a Review of the Literature. Transplantation 2017; 101:e166-e169. [PMID: 28263223 DOI: 10.1097/tp.0000000000001721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Persistently elevated eosinophil granulocytes in the peripheral blood in children is challenging because of a complex diagnosis especially after solid organ transplantation and can lead to difficulties in finding an underlying causative factor.We report a 12-year-old boy who developed severe hypereosinophilia 11 years after liver transplantation due to biliary atresia. Accompanying symptoms were recurrent fever, fatigue, elevated liver enzymes, abdominal pain, and significant weight loss. After exclusion of secondary causes of eosinophilia, an idiopathic hypereosinophilic syndrome (I-HES) was diagnosed. Treatment with prednisolone resulted in an immediate response with rapid reduction of eosinophils, normalization of liver enzymes, and amelioration of any clinical symptoms. A hypereosinophilic syndrome in patients after liver transplantation is rare, and a broad differential diagnosis has to be considered. Prednisolone may lead to a prompt amelioration of eosinophilia and associated symptoms.
Collapse
|
23
|
Bonou M, Kapelios CJ, Benetos G, Moyssakis I, Giannakopoulou N, Diamantopoulos P, Korkolopoulou P, Variami E, Barbetseas J. Hypereosinophilic Syndrome as a Rare Cause of Reversible Biventricular Heart Failure. Can J Cardiol 2017; 33:688.e5-688.e7. [PMID: 28347583 DOI: 10.1016/j.cjca.2017.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 01/06/2017] [Accepted: 01/06/2017] [Indexed: 11/27/2022] Open
Abstract
Hypereosinophilic syndrome is a rare entity that can develop secondary to overproduction of eosinophilopoietic cytokines or as idiopathic disease. Cardiac involvement, which occurs often, is divided into 3 stages, the latter of which is nonreversible and leads to severe heart failure. Early detection and treatment of the syndrome is essential. For this reason, genetic testing for the FIP1L1-PDGFRA fusion gene has recently been added to the diagnostic algorithm. Patients with this mutation are at increased risk for the development of cardiac involvement and typically respond to treatment with the tyrosine kinase inhibitor imatinib mesylate.
Collapse
Affiliation(s)
- Maria Bonou
- Department of Cardiology, Laikon General Hospital, Athens, Greece.
| | - Chris J Kapelios
- Department of Cardiology, Laikon General Hospital, Athens, Greece
| | - George Benetos
- Department of Cardiology, Laikon General Hospital, Athens, Greece
| | | | - Nefeli Giannakopoulou
- First Department of Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Panagiotis Diamantopoulos
- First Department of Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Eleni Variami
- First Department of Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - John Barbetseas
- Department of Cardiology, Laikon General Hospital, Athens, Greece
| |
Collapse
|
24
|
Fikal S, Sajiai H, Serhane H, Aitbatahar S, Amro L. [Eosinophilic pneumonia revealing B-cell non-Hodgkin lymphoma]. Pan Afr Med J 2017; 24:292. [PMID: 28154647 PMCID: PMC5267790 DOI: 10.11604/pamj.2016.24.292.9138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 03/08/2016] [Indexed: 11/11/2022] Open
Abstract
The diagnosis of eosinophilic pneumonia is rare and malignant etiology remains exceptional. Eosinophilic pneumonia etiology varies and is mainly dominated by allergic and drug causes. We report the case of a 61-year-old patient with B-cell non-Hodgkin lymphoma revealed by eosinophilic pneumonia. The diagnosis of eosinophilic pneumonia was confirmed by eosinophil count of 56% in bronchoalveolar lavage. Immunohistochemical examination of bone marrow biopsy revealed malignant Small B cells non-Hodgkin lymphoma.
Collapse
Affiliation(s)
- Siham Fikal
- Service de Pneumologie, Hôpital Arrazi, CHU Mohammed VI, FMPM, Labo PCIM, UCA, Marrakech, Maroc
| | - Hafsa Sajiai
- Service de Pneumologie, Hôpital Arrazi, CHU Mohammed VI, FMPM, Labo PCIM, UCA, Marrakech, Maroc
| | - Hind Serhane
- Service de Pneumologie, Hôpital Arrazi, CHU Mohammed VI, FMPM, Labo PCIM, UCA, Marrakech, Maroc
| | - Salma Aitbatahar
- Service de Pneumologie, Hôpital Arrazi, CHU Mohammed VI, FMPM, Labo PCIM, UCA, Marrakech, Maroc
| | - Lamyae Amro
- Service de Pneumologie, Hôpital Arrazi, CHU Mohammed VI, FMPM, Labo PCIM, UCA, Marrakech, Maroc
| |
Collapse
|
25
|
Abstract
Historically, eosinophils have been considered as end-stage cells involved in host protection against parasitic infection and in the mechanisms of hypersensitivity. However, later studies have shown that this multifunctional cell is also capable of producing immunoregulatory cytokines and soluble mediators and is involved in tissue homeostasis and modulation of innate and adaptive immune responses. In this review, we summarize the biology of eosinophils, including the function and molecular mechanisms of their granule proteins, cell surface markers, mediators, and pathways, and present comprehensive reviews of research updates on the genetics and epigenetics of eosinophils. We describe recent advances in the development of epigenetics of eosinophil-related diseases, especially in asthma. Likewise, recent studies have provided us with a more complete appreciation of how eosinophils contribute to the pathogenesis of various diseases, including hypereosinophilic syndrome (HES). Over the past decades, the definition and criteria of HES have been evolving with the progress of our understanding of the disease and some aspects of this disease still remain controversial. We also review recent updates on the genetic and molecular mechanisms of HES, which have spurred dramatic developments in the clinical strategies of diagnosis and treatment for this heterogeneous group of diseases. The conclusion from this review is that the biology of eosinophils provides significant insights as to their roles in health and disease and, furthermore, demonstrates that a better understanding of eosinophil will accelerate the development of new therapeutic strategies for patients.
Collapse
|
26
|
Abstract
The symptomatic hypereosinophilic patient must be approached in a stepwise manner, with thorough assessment to determine whether the hypereosinophilia itself is contributing to damage and disease manifestations (thereby defining a hypereosinophilic syndrome), and to identify an eventual cause of hypereosinophilia, followed by initiation of treatment directed against the underlying condition or deleterious hypereosinophilic state. Situations encountered in the clinic are extremely heterogeneous because of the numerous potential causes of hypereosinophilia and the variable spectrum of eosinophil-mediated organ damage. A practical approach to many of these situations is presented in this review.
Collapse
|
27
|
Chang ME, Teng HW. Salvage therapy of imatinib-resistant hypereosinophilic syndrome with PDGFRB rearrangement. JOURNAL OF CANCER RESEARCH AND PRACTICE 2016. [DOI: 10.1016/j.jcrpr.2015.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
|
28
|
|
29
|
Lefèvre G, Copin MC, Roumier C, Aubert H, Avenel-Audran M, Grardel N, Poulain S, Staumont-Sallé D, Seneschal J, Salles G, Ghomari K, Terriou L, Leclech C, Morati-Hafsaoui C, Morschhauser F, Lambotte O, Ackerman F, Trauet J, Geffroy S, Dumezy F, Capron M, Roche-Lestienne C, Taieb A, Hatron PY, Dubucquoi S, Hachulla E, Prin L, Labalette M, Launay D, Preudhomme C, Kahn JE. CD3-CD4+ lymphoid variant of hypereosinophilic syndrome: nodal and extranodal histopathological and immunophenotypic features of a peripheral indolent clonal T-cell lymphoproliferative disorder. Haematologica 2015; 100:1086-95. [PMID: 25682606 PMCID: PMC5004425 DOI: 10.3324/haematol.2014.118042] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Accepted: 02/10/2015] [Indexed: 11/09/2022] Open
Abstract
The CD3(-)CD4(+) lymphoid variant of hypereosinophilic syndrome is characterized by hypereosinophilia and clonal circulating CD3(-)CD4(+) T cells. Peripheral T-cell lymphoma has been described during this disease course, and we observed in our cohort of 23 patients 2 cases of angio-immunoblastic T-cell lymphoma. We focus here on histopathological (n=12 patients) and immunophenotypic (n=15) characteristics of CD3(-)CD4(+) lymphoid variant of hypereosinophilic syndrome. Atypical CD4(+) T cells lymphoid infiltrates were found in 10 of 12 CD3(-)CD4(+) L-HES patients, in lymph nodes (n=4 of 4 patients), in skin (n=9 of 9) and other extra-nodal tissues (gut, lacrymal gland, synovium). Lymph nodes displayed infiltrates limited to the interfollicular areas or even an effacement of nodal architecture, associated with proliferation of arborizing high endothelial venules and increased follicular dendritic cell meshwork. Analysis of 2 fresh skin samples confirmed the presence of CD3(-)CD4(+) T cells. Clonal T cells were detected in at least one tissue in 8 patients, including lymph nodes (n=4 of 4): the same clonal T cells were detected in blood and in at least one biopsy, with a maximum delay of 23 years between samples. In the majority of cases, circulating CD3(-)CD4(+) T cells were CD2(hi) (n=9 of 14), CD5(hi) (n=12 of 14), and CD7(-)(n=4 of 14) or CD7(low) (n=10 of 14). Angio-immunoblastic T-cell lymphoma can also present with CD3(-)CD4(+) T cells; despite other common histopathological and immunophenotypic features, CD10 expression and follicular helper T-cell markers were not detected in lymphoid variant of hypereosinophilic syndrome patients, except in both patients who developed angio-immunoblastic T-cell lymphoma, and only at T-cell lymphoma diagnosis. Taken together, persistence of tissular clonal T cells and histopathological features define CD3(-)CD4(+) lymphoid variant of hypereosinophilic syndrome as a peripheral indolent clonal T-cell lymphoproliferative disorder, which should not be confused with angio-immunoblastic T-cell lymphoma.
Collapse
Affiliation(s)
- Guillaume Lefèvre
- Institute of Immunology, French Eosinophil Network and Research Unit EA2686, Lille University Hospital, Université Lille Nord de France, Lille Department of Internal Medicine - Clinical Immunology Unit and Research Unit EA2686, Lille University Hospital, Université Lille Nord de France, Lille
| | - Marie-Christine Copin
- Institute of Pathology and CNRS Unit Research UMR 8161, Lille University Hospital, Université Lille Nord de France, Lille
| | - Christophe Roumier
- Institute of Hematology and Inserm Unit U837, Lille University Hospital, Université Lille Nord de France, Lille
| | - Hélène Aubert
- Department of Dermatology, Nantes University Hospital, Nantes
| | | | - Nathalie Grardel
- Institute of Hematology and Inserm Unit U837, Lille University Hospital, Université Lille Nord de France, Lille
| | - Stéphanie Poulain
- Institute of Hematology and Inserm Unit U837, Lille University Hospital, Université Lille Nord de France, Lille
| | - Delphine Staumont-Sallé
- Department of Dermatology, Lille University Hospital, Université Lille Nord de France, Lille
| | - Julien Seneschal
- Department of Dermatology and Pediatric Dermatology, National Reference Center for Rare Skin Diseases and Inserm Unit Research U1035, Bordeaux University Hospital, Bordeaux
| | - Gilles Salles
- Department of Hematology, Lyon Sud University Hospital, Hospices Civils de Lyon, Lyon 1 University, Bron
| | | | - Louis Terriou
- Department of Internal Medicine - Clinical Immunology Unit and Research Unit EA2686, Lille University Hospital, Université Lille Nord de France, Lille
| | - Christian Leclech
- Department of Dermatology, Angers University Hospital and UNAM University, Angers
| | | | - Franck Morschhauser
- Department of Internal Medicine, Bicêtre University Hospital - APHP, Paris Sud XI University, Le Kremlin-Bicêtre
| | - Olivier Lambotte
- Department of Hematology, Lille University Hospital, Université Lille Nord de France, Lille
| | - Félix Ackerman
- Department of Hematology, Lille University Hospital, Université Lille Nord de France, Lille
| | - Jacques Trauet
- Institute of Immunology, French Eosinophil Network and Research Unit EA2686, Lille University Hospital, Université Lille Nord de France, Lille
| | - Sandrine Geffroy
- Institute of Hematology and Inserm Unit U837, Lille University Hospital, Université Lille Nord de France, Lille
| | - Florent Dumezy
- Institute of Hematology and Inserm Unit U837, Lille University Hospital, Université Lille Nord de France, Lille
| | - Monique Capron
- Inserm Unit Research U995, Lille University Hospital, Université Lille Nord de France, Lille
| | - Catherine Roche-Lestienne
- Institut de Génétique Médicale, Inserm Unit U837, Lille University Hospital, Université Lille Nord de France, Lille
| | - Alain Taieb
- Department of Dermatology and Pediatric Dermatology, National Reference Center for Rare Skin Diseases and Inserm Unit Research U1035, Bordeaux University Hospital, Bordeaux
| | - Pierre-Yves Hatron
- Department of Internal Medicine - Clinical Immunology Unit and Research Unit EA2686, Lille University Hospital, Université Lille Nord de France, Lille
| | - Sylvain Dubucquoi
- Institute of Immunology, French Eosinophil Network and Research Unit EA2686, Lille University Hospital, Université Lille Nord de France, Lille
| | - Eric Hachulla
- Institute of Immunology, French Eosinophil Network and Research Unit EA2686, Lille University Hospital, Université Lille Nord de France, Lille Department of Internal Medicine - Clinical Immunology Unit and Research Unit EA2686, Lille University Hospital, Université Lille Nord de France, Lille
| | - Lionel Prin
- Institute of Immunology, French Eosinophil Network and Research Unit EA2686, Lille University Hospital, Université Lille Nord de France, Lille
| | - Myriam Labalette
- Institute of Immunology, French Eosinophil Network and Research Unit EA2686, Lille University Hospital, Université Lille Nord de France, Lille
| | - David Launay
- Institute of Immunology, French Eosinophil Network and Research Unit EA2686, Lille University Hospital, Université Lille Nord de France, Lille Department of Internal Medicine - Clinical Immunology Unit and Research Unit EA2686, Lille University Hospital, Université Lille Nord de France, Lille
| | - Claude Preudhomme
- Institute of Hematology and Inserm Unit U837, Lille University Hospital, Université Lille Nord de France, Lille
| | - Jean-Emmanuel Kahn
- Institute of Immunology, French Eosinophil Network and Research Unit EA2686, Lille University Hospital, Université Lille Nord de France, Lille Department of Internal Medicine, Foch Hospital and Versailles-Saint-Quentin-en-Yvelines University, Suresnes, France
| |
Collapse
|
30
|
Merika EE, Lefroy D, Milojkovic D, Wakelin SH. Hypereosinophilic syndrome: an indolent rash with a serious cardiac complication. Clin Exp Dermatol 2015. [PMID: 26213289 DOI: 10.1111/ced.12709] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Idiopathic hypereosinophilic syndrome (HES) is a rare disorder, characterized by prominent blood or tissue eosinophilia with ensuing tissue damage, which is diagnosed after exclusion of underlying diseases known to cause HES. Sustained eosinophilia is associated with cardiac disease, including endomyocardial thrombosis and fibrosis, leading to restrictive cardiomyopathy, valvular dysfunction and increased thrombotic tendency. Aneurysmal coronary artery disease (CAD) occurring in the absence of stenotic atherosclerotic plaques is extremely rare. We present a case of idiopathic HES in a 30-year-old woman with asymptomatic multianeurysmal CAD and a sinus of Valsalva aneurysm, and discuss a brief review of the literature and management strategies.
Collapse
Affiliation(s)
- E E Merika
- St Mary's Hospital, Imperial College London NHS Trust, London, UK
| | - D Lefroy
- St Mary's Hospital, Imperial College London NHS Trust, London, UK
| | - D Milojkovic
- St Mary's Hospital, Imperial College London NHS Trust, London, UK
| | - S H Wakelin
- St Mary's Hospital, Imperial College London NHS Trust, London, UK
| |
Collapse
|
31
|
Kim JK, Kim JH, Park HM, Jeong YS, Choi CJ, Na SK, Kim JH, Song YR, Hwang YI, Jang SH, Jung KS. Idiopathic hypereosinophilic syndrome presenting with urinary frequency, abdominal pain, and diarrhea. ALLERGY ASTHMA & RESPIRATORY DISEASE 2015. [DOI: 10.4168/aard.2015.3.1.77] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Ja-Kyung Kim
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Joo-Hee Kim
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Han-Min Park
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Yong-Seol Jeong
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Chung-Jo Choi
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Seong-Kyun Na
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Jong-Hyeok Kim
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Young-Rim Song
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Yong-Il Hwang
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Seung-Hun Jang
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Ki-Suck Jung
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
| |
Collapse
|
32
|
Sauvage D, Roufosse F, Sanoussi I, Massin M, Rooze S, De Ville A, Azzi N, Huybrechts S, Dedeken L, Devalck C, Ferster A. Treatment-refractory hypereosinophilic syndrome responding to fludarabine in a 12-year-old boy. Leuk Lymphoma 2015; 56:2711-3. [PMID: 25549807 DOI: 10.3109/10428194.2014.1003058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Delphine Sauvage
- a Department of Pediatric Hemato-oncology , Hôpital Universitaire des Enfants Reine Fabiola , Brussels , Belgium
| | - Florence Roufosse
- b Department of Internal Medicine , Hôpital Erasme, Université Libre de Bruxelles , Brussels , Belgium
| | - Ismail Sanoussi
- c Department of Pediatrics , Hôpital Universitaire des Enfants Reine Fabiola , Brussels , Belgium
| | - Martial Massin
- d Department of Pediatric Cardiology , Hôpital Universitaire des Enfants Reine Fabiola , Brussels , Belgium
| | - Shancy Rooze
- e Intensive Care Unit, Hôpital Universitaire des Enfants Reine Fabiola , Brussels , Belgium
| | - Andrée De Ville
- f Department of Anesthesiology , Hôpital Universitaire des Enfants Reine Fabiola , Brussels , Belgium
| | - Nadira Azzi
- a Department of Pediatric Hemato-oncology , Hôpital Universitaire des Enfants Reine Fabiola , Brussels , Belgium
| | - Sophie Huybrechts
- a Department of Pediatric Hemato-oncology , Hôpital Universitaire des Enfants Reine Fabiola , Brussels , Belgium
| | - Laurence Dedeken
- a Department of Pediatric Hemato-oncology , Hôpital Universitaire des Enfants Reine Fabiola , Brussels , Belgium
| | - Christine Devalck
- a Department of Pediatric Hemato-oncology , Hôpital Universitaire des Enfants Reine Fabiola , Brussels , Belgium
| | - Alina Ferster
- a Department of Pediatric Hemato-oncology , Hôpital Universitaire des Enfants Reine Fabiola , Brussels , Belgium
| |
Collapse
|
33
|
Mahajan VK, Singh R, Mehta KS, Chauhan PS, Sharma S, Gupta M, Rawat R. Idiopathic hypereosinophilic syndrome: a rare cause of erythroderma. J Dermatol Case Rep 2014; 8:108-14. [PMID: 25621091 DOI: 10.3315/jdcr.2014.1185] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Accepted: 12/08/2014] [Indexed: 01/19/2023]
Abstract
BACKGROUND Idiopathic hypereosinophilic syndrome (HES) is a rare and potentially lethal disorder characterized by persistently elevated eosinophil counts without any underlying causes. Two variants, the myeloproliferative and lymphocytic hypereosinophilic syndrome, have been identified. The symptoms are variable and related to the organs involved (cardiovascular system, skin, central and peripheral nervous system, gastrointestinal tract, eyes). Skin lesions can be the dominating and/or presenting symptom in about 50% of patients. MAIN OBSERVATIONS We describe a 54-year-old man with a 12-year history of skin lesions, clinically consistent with psoriasis and psoriatic erythroderma. The patient was treated with methotrexate with no response. He experienced intense pruritus, dry/coarse skin and palmoplantar hyperkeratosis. Histopathology showed spongiotic dermatitis with no epidermotropism. Inflammatory infiltrates in upper dermis consisted predominantly of lymphocytes and eosinophils. Peripheral and tissue eosinophilia, immunophenotyping, and results of FIP1L1-PDGFRA gene analysis were suggestive of lymphocytic HES. The patient was treated with hydroxycarbamide (1 g/day), prednisolone (40 mg/day) and antihistamines with improvement. CONCLUSIONS HES requires early treatment to prevent severe damage of targeted organs. The pleomorphic dermatological manifestations may delay the diagnosis. This case shows the importance of wide differential diagnosis of erythroderma. In this article we discuss the diagnostic criteria, the recommended work-up and management of idiopathic hypereosinophilic syndrome variants.
Collapse
Affiliation(s)
- Vikram K Mahajan
- Department of Dermatology, Venereology & Leprosy, Dr. Rajendra Prasad Government Medical College, Kangra (Tanda), Himachal Pradesh - 176001, India
| | - Ravinder Singh
- Department of Dermatology, Venereology & Leprosy, Dr. Rajendra Prasad Government Medical College, Kangra (Tanda), Himachal Pradesh - 176001, India
| | - Karaninder S Mehta
- Department of Dermatology, Venereology & Leprosy, Dr. Rajendra Prasad Government Medical College, Kangra (Tanda), Himachal Pradesh - 176001, India
| | - Pushpinder S Chauhan
- Department of Dermatology, Venereology & Leprosy, Dr. Rajendra Prasad Government Medical College, Kangra (Tanda), Himachal Pradesh - 176001, India
| | - Saurabh Sharma
- Department of Pathology, Dr. Rajendra Prasad Government Medical College, Kangra (Tanda), Himachal Pradesh - 176001, India
| | - Mrinal Gupta
- Department of Dermatology, Venereology & Leprosy, Dr. Rajendra Prasad Government Medical College, Kangra (Tanda), Himachal Pradesh - 176001, India
| | - Ritu Rawat
- Department of Dermatology, Venereology & Leprosy, Dr. Rajendra Prasad Government Medical College, Kangra (Tanda), Himachal Pradesh - 176001, India
| |
Collapse
|
34
|
Hypereosinophilic syndrome. Ann Allergy Asthma Immunol 2014; 112:484-8. [PMID: 24726650 DOI: 10.1016/j.anai.2014.03.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Revised: 03/06/2014] [Accepted: 03/09/2014] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To summarize the identified molecular and cellular mechanisms relevant to clinicians evaluating patients with hypereosinophilic syndrome (HES). DATA SOURCES Review of relevant peer-reviewed literature. STUDY SELECTIONS Studies on the pathogenesis of HES in relation to consensus definitions, disease classification, mechanisms of disease, and diagnosis and treatment are included. RESULTS Changes to the definition of HES have been proposed based on recent studies identifying specific cellular and molecular disease phenotypes. Identification of specific mechanisms of disease may have clinical and therapeutic significance. Despite recent advances, in most cases the molecular pathogenesis of HES remains unknown. CONCLUSION Identification of specific HES disease mechanisms empowers the practicing clinician to offer specific mechanism-based treatment options to patients with HES in their clinical practice.
Collapse
|
35
|
Shehwaro N, Langlois AL, Gueutin V, Izzedine H. Renal involvement in idiopathic hypereosinophic syndrome. Clin Kidney J 2013; 6:272-6. [PMID: 26064485 PMCID: PMC4400489 DOI: 10.1093/ckj/sft046] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2013] [Accepted: 04/01/2013] [Indexed: 11/14/2022] Open
Abstract
The hypereosinophilic syndromes (HESs) are a group of disorders marked by the sustained overproduction of eosinophils, in which eosinophilic infiltration and mediator release cause damage to multiple organs. In idiopathic HES, the underlying cause of hypereosinophilia (HE) remains unknown despite thorough aetiological work-up. Kidney disease is thought to be rare in HES. Renal manifestations described include eosinophilic interstitial nephritis, various types of glomerulopathies, thrombotic microangiopathy (TMA) and electrolyte disturbances. The diagnosis must be made in time, because a recovery of renal function can be obtained if treatment is initiated promptly.
Collapse
Affiliation(s)
- Nathalie Shehwaro
- Department of Nephrology , Pitie Salpetriere Hospital , Paris , France
| | | | - Victor Gueutin
- Department of Nephrology , Pitie Salpetriere Hospital , Paris , France
| | - Hassane Izzedine
- Department of Nephrology , Pitie Salpetriere Hospital , Paris , France
| |
Collapse
|
36
|
Hypereosinophilic syndrome - lymphocytic variant transforming into peripheral T-cell lymphoma with severe oral manifestations. Oral Surg Oral Med Oral Pathol Oral Radiol 2013; 116:e185-90. [PMID: 23669204 DOI: 10.1016/j.oooo.2013.03.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2012] [Revised: 03/14/2013] [Accepted: 03/21/2013] [Indexed: 01/05/2023]
Abstract
Hypereosinophilic syndrome (HES) is a rare disease defined by organ damage directly attributable to hypereosinophilia of any type. Here, we report for the first time the case of a patient with a lymphocytic type of HES (HES-L) who had liver, skin, spleen, lung, bone marrow, digestive track, and mouth involvement. Associated T-cells displayed an aberrant CD30+ phenotype and were monoclonal. Thymus activated and regulated chemokine serum level was positive. Despite steroids (Cortancyl 20 mg [Sanofi Aventis, France], imatinib mesylate [Glivec 400 mg; Novartis Europharm], interferon alpha 2A [Roferon-A 3 MUI/0.5 ml; Roche]) and other lines of therapy including imatinib mesylate treatment, an oral necrotic lesion developed, and finally progressed into a peripheral CD30+ T-cell lymphoma. CHOP chemotherapy (cyclophosphamide, hydroxydoxorubicin, oncovin, prednisone), interferon-α, and mepolizumab were ineffective. Although progression into peripheral T-cell lymphoma is documented as a rare complication of HES-L, severe oral extension of HES-L is described for the first time.
Collapse
|