Okafor Ndubuisi C, Oso Ayodeji A, Oranu Amanke C, Wolff Steven M, Murray John J
Department of Internal Medicine, Meharry Medical College, Nashville, TN 37208, USA.
Case Rep Med. 2009;2009:635309. doi: 10.1155/2009/635309. Epub 2010 Jan 12.
Several causes of eosinophilic pleural effusions have been described with malignancy being the commonest cause. Hypereosinophilic syndrome (HES) is a rare disease and very few cases have been reported of HES presenting as eosinophilic pleural effusion (EPE). We report a case of a 26-year-old male who presented with shortness of breath. He had bilateral pleural effusions, generalized lymphadenopathy, splenomegaly, and leukocytosis with marked peripheral blood eosinophilia. The pleural fluid was exudative, with 25%-30% eosinophilis, and absence of neoplastic cells. Hypereosinophilic syndrome was diagnosed after other causes of eosinophilia were excluded. He continued to be dyspneic with persistent accumulation of eosinophilic pleural fluid, even after his peripheral eosinophil count had normalized in response to treatment. This patient represents a very unusual presentation of HES with dyspnea and pleural effusions and demonstrates that treatment based on response of peripheral eosinophil counts, as is currently recommended, may not always be clinically adequate.
嗜酸性胸腔积液的病因有多种，其中恶性肿瘤是最常见的病因。高嗜酸性粒细胞综合征（HES）是一种罕见疾病，很少有HES表现为嗜酸性胸腔积液（EPE）的病例报道。我们报告一例26岁男性，表现为呼吸急促。他有双侧胸腔积液、全身淋巴结肿大、脾肿大以及白细胞增多伴外周血嗜酸性粒细胞显著增多。胸腔积液为渗出液，嗜酸性粒细胞占25%-30%，且无肿瘤细胞。排除其他嗜酸性粒细胞增多的病因后，诊断为高嗜酸性粒细胞综合征。即使在治疗后外周嗜酸性粒细胞计数恢复正常，他仍持续存在呼吸困难且嗜酸性胸腔积液不断积聚。该患者代表了HES一种非常不寻常的表现形式，伴有呼吸困难和胸腔积液，表明目前推荐的基于外周嗜酸性粒细胞计数反应的治疗方法在临床上可能并不总是足够的。
