Ponsky Todd A, Brody Fredrick, Giordano Joseph, Garcia Ryan, Kardon David, Schwartz Arnold
Department of Surgery, The George Washington University School of Medicine, Washington, DC, USA.
J Vasc Surg. 2005 Oct;42(4):796-9. doi: 10.1016/j.jvs.2005.05.050.
Hypereosinophilic syndrome (HES) is characterized by an overproduction of eosinophils that leads to organ damage. Although most cases of HES frequently affect the lungs, heart, and gastrointestinal tract, there are a few reported cases of peripheral vascular involvement. We report a case of a patient with a history of colonic HES who presented with idiopathic occlusion of the brachial artery. A 28-year-old woman with a recent history of eosinophilic colitis presented with a several-week history of left hand pain, pallor, and paresthesias. Her hand was cool, without palpable pulses. Her eosinophilia count was 38%. An arteriogram documented a left brachial artery occlusion and diffuse left arm vasospasm. A brachial-to-brachial bypass was performed. Postoperatively, there was extensive vasospasm of her distal upper extremity arteries, which was treated with calcium-channel blockers and steroids. Her symptoms resolved and she has been asymptomatic for 9 months. The segment of occluded artery was found to contain many eosinophils on histologic examination. HES of the arterial system is an exceedingly rare cause of occlusion. Our patient presented with eosinophilia, arterial vasospasm with subsequent occlusion, and the presence of eosinophilic infiltration on the pathologic specimen. These data, combined with the patient's previous history, demonstrate that the patient's occlusion may have been secondary to HES.
高嗜酸性粒细胞综合征（HES）的特征是嗜酸性粒细胞过度生成，进而导致器官损害。尽管大多数HES病例常累及肺部、心脏和胃肠道，但也有少数关于外周血管受累的报道病例。我们报告一例有结肠HES病史的患者，其出现了肱动脉特发性闭塞。一名近期有嗜酸性粒细胞性结肠炎病史的28岁女性，出现了数周的左手疼痛、苍白和感觉异常。她的手部冰凉，未触及脉搏。她的嗜酸性粒细胞计数为38%。血管造影显示左肱动脉闭塞及左臂弥漫性血管痉挛。进行了肱动脉至肱动脉搭桥手术。术后，其远端上肢动脉出现广泛血管痉挛，采用钙通道阻滞剂和类固醇进行治疗。她的症状得到缓解，且9个月来一直无症状。组织学检查发现闭塞动脉段含有许多嗜酸性粒细胞。动脉系统的HES是一种极其罕见的闭塞原因。我们的患者表现为嗜酸性粒细胞增多、动脉血管痉挛继而闭塞，且病理标本中有嗜酸性粒细胞浸润。这些数据，结合患者既往病史，表明患者的闭塞可能继发于HES。
