Division of Hematology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
Division of Rheumatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
BMJ Case Rep. 2021 Jan 28;14(1):e236592. doi: 10.1136/bcr-2020-236592.
A high functioning 74-year-old man with systemic lupus erythematosus presented to the emergency department with acute anxiety. He was found to have elevated cardiac enzymes and admitted to the cardiology service for investigation. In hospital, he developed an erythematous papular rash, and deteriorated to being somnolent and bedridden. He was found to have new multiterritory ischaemic strokes. It was eventually noted that he had persistent eosinophilia, present even on admission, which had been overlooked as the total leucocyte count was normal. Serology for antiphospholipid antibody syndrome (APS) was positive. He was diagnosed with hypereosinophilic syndrome (HES) secondary to new APS, and responded to high-dose steroids. This case highlights the importance of fully evaluating a leucocyte differential to make a diagnosis of HES. We discuss the definition, clinical manifestations, diagnostic approach and management of this important condition.
一位 74 岁的高功能系统性红斑狼疮男性患者因急性焦虑到急诊就诊。他的心肌酶升高，被收入心内科进行检查。住院期间，他出现红斑丘疹性皮疹，并逐渐变得嗜睡和卧床不起。他被发现有新发多部位缺血性中风。最终注意到他有持续的嗜酸性粒细胞增多，即使在入院时也存在，这被忽视了，因为白细胞总数正常。抗磷脂抗体综合征（APS）的血清学检查呈阳性。他被诊断为继发于新 APS 的嗜酸性粒细胞增多综合征（HES），并对大剂量类固醇有反应。本例强调了全面评估白细胞分类以诊断 HES 的重要性。我们讨论了这种重要疾病的定义、临床表现、诊断方法和治疗。
