Hypereosinophilic Syndrome with Cardiac Involvement in a Pregnant Patient with Multiple Sclerosis

摘要

In hypereosinophilic syndrome, the sustained overproduction of eosinophils leads to the dysfunction of one or more organs. Symptoms vary in accordance with which organ is affected. Cardiac involvement leads to substantial morbidity and to most of the deaths that are associated with hypereosinophilic syndrome. Herein, we present the case of a 31-year-old woman, pregnant for 12 weeks and with a history of multiple sclerosis, who presented with transient vision loss and splinter hemorrhages in her fingernail beds. The diagnosis was hypereosinophilic syndrome with cardiac involvement. Echocardiography revealed 2 echodense structures: one that obliterated the left ventricular apex, and another in the basal lateral wall. The patient underwent therapy with prednisone and heparin but developed heparin-induced thrombocytopenia. This condition resolved when argatroban was substituted for heparin. Two weeks after the patient's release from the hospital, echocardiography revealed improvement in the echodense ventricular structures. The transient vision loss and the splinter hemorrhages were attributed to the hypereosinophilic syndrome. We believe that this is the 1st report of a pregnant patient with hypereosinophilic syndrome and cardiac involvement. Key words: Cardiovascu-lar diseases/complications, eosinophilia/complications/diagnosis/drug therapy, hypereosinophilic syndrome/diagnosis/therapy, neurologic manifestations, pregnancy complications, hematologic/drug therapy, treatment outcome Hypereosinophilic syndrome (HES) is characterized by the sustained overproduction of eosinophils. Eosinophilic infiltration and mediator release cause damage to one or more organs. 1 The symptoms vary, depending upon which organ is involved. The diagnostic criteria for HES include peripheral blood eosinophilia >1,500 ×106/L, the absence of a secondary cause of eosinophilia, and evidence of a related organ dysfunction. 2 Hypereosinophilic syndrome frequently affects the skin, central nervous system, gastrointestinal tract, and lungs. 2,3 Cardiovascular sequelae of HES are commonly seen, and they are a major cause of morbidity and death. 4 The onset of HES symptoms is frequently insidious, and the eosinophilia is detected incidentally. However, in some patients, the presenting manifestation is severe and life-threatening due to rapidly developing cardiac or neurologic complications. 4 The treatment of HES largely depends upon the patient's presentation, the laboratory findings, and the results of mutational analysis. First-line therapy in most patients involves glucocorticoids. Herein, we discuss the case of a pregnant patient with HES and cardiac involvement.