Hypereosinophilia with multi-organ dysfunction: a puzzler!
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Hypereosinophilic syndromes (HES) are a group of disorders characterised by blood eosinophilia greater than 1500/mm3 on at least two occasions and eosinophilic infiltration and damage to multiple organs. A significant number of cases of HES are commonly missed and therefore a systematic approach is necessary for all such patients. Through the present case, presented in the Journal of Association of Physician's of India, the authors summarise how to systematically approach a case of HES and manage it.

A 35 year old male presented with complaints of on and off fever, generalised rash, shortness of breath and loose stools for the last 3-4 years. The patient was apparently well till around 4 years back when he started having fever; which was intermittent, low-moderate in intensity, without any recognizable pattern, associated with chills but no rigors and responded to anti-pyretics. For this complaint he had consulted local doctors and was told to have enteric fever on multiple occasions and was prescribed multiple courses of antibiotics for the same, without any strong evidence in favour of the diagnosis (review of records showed only weakly positive Widal titres).

Records also showed persistent eosinophilia and anaemia which was attributed to worm infestation and was treated with albendazole on multiple occasions. However, 3 months after onset of fever, the patient also developed generalised maculo-papular rashes over body and extremities, which were mildly itchy but not associated with scaling or any serous/ purulent discharge. The rashes used to come in crops, responded to antihistaminics and usually healed with hyperpigmentation.
Read more here: Continue to read here about the case here: http://www.japi.org/november_2018/cm1.html
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