HYPEREOSINOPHILIA PRESENTING AS DIGITAL ISCHEMIA AND CEREBRAL VASCULITIS
Rezgui Amel*, Karmani Monia, Ben Hassine Imen, Ben Fredj Fatma, Mzabi Anis and Laouani Chedia
Hypereosinophilic syndrome is characterized by an overproduction of eosinophils that leads to organ damage. Although most cases of this syndrome frequently affect the heart, lungs and gastrointestinal tract, there are a few reported cases of vascular involvement We report here a case with hypereosinophilia, peripheral artery occlusion, digital ischemia , cutaneous and cerebral vasculitis. A 47-year-old Tunisian man presented to us with purpura on lower extremity, swelling and pain on upper extremity and cyanosis of his fingers. Arterial Doppler revealed occlusion of radial and ulnar arteries. The biopsy specimen showed perivascular and periadnexal dense eosinophilic infiltration in dermis and subcutaneous adipose tissue. Laboratory investigations revealed a persistent hypereosinophilia. He was prescribed prednisolone 80 mg daily with nifedipine and Iloprost. His skin lesion, pain and digital ischemia were improved and the eosinophil count was dramatically decreased. After discharge, eosinophil count gradually increased again. Dysarthria and left hemiparesis occurred. The MRI showed lesions of cerebral vasculitis. We prescribed prednisolone, cyclophosphamide and clopidogrel with good results.
Keywords: hypereosinophilia, artery occlusion, vasculitis.
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