title: Hypereosinophilia presenting as eosinophilic vasculitis and multiple peripheral artery occlusions without organ involvement.
abstract: We report here a case with hypereosinophilia and peripheral artery occlusion. A 32-yr-old Korean woman presented to us with lower extremity swelling and pain. Angiography revealed that multiple lower extremity arteries were occlusive. The biopsy specimen showed perivascular and periadnexal dense eosinophilic infiltration in dermis and subcutaneous adipose tissue. Laboratory investigations revealed a persistent hypereosinophilia. She was prescribed prednisolone 60 mg daily. Her skin lesion and pain were improved and the eosinophil count was dramatically decreased. After discharge, eosinophil count gradually increased again. Cyanosis and pain of her fingers recurred. She had been treated with cyclophosphamide pulse therapy. Her eosinophilia was decreased, but the cyanosis and tingling sense were progressive. The extremity arterial stenoses were slightly progressed. Skin biopsy showed perivascular eosinophilic infiltration in the dermis and CD40 ligand (CD40L) positive eosinophilic infiltration. The serum TNF-alpah was markedly increased. These results suggest that CD40L (a member of TNF-alpah superfamily) could play a role in the inflammatory processes when eosinophil infiltration and activation are observed. We prescribed prednisolone, cyclophosphamide, clopidogrel, cilostazol, beraprost and nifedipine, and she was discharged.
authors.affiliation: Department of Internal Medicine, Seoul National University College of Medicine, Korea.
authors.forename: Sung-Hwan
authors.initials: SH
authors.lastname: Kim
authors.forename: Tae-Bum
authors.initials: TB
authors.lastname: Kim
authors.forename: Young-Sun
authors.initials: YS
authors.lastname: Yun
authors.forename: Jung-Im
authors.initials: JI
authors.lastname: Shin
authors.forename: Il-Young
authors.initials: IY
authors.lastname: Oh
authors.forename: Jung-Ju
authors.initials: JJ
authors.lastname: Sir
authors.forename: Kyung-Mook
authors.initials: KM
authors.lastname: Kim
authors.forename: Hye-Kyung
authors.initials: HK
authors.lastname: Park
authors.forename: Hye-Ryun
authors.initials: HR
authors.lastname: Kang
authors.forename: Yoon-Seok
authors.initials: YS
authors.lastname: Chang
authors.forename: Yoon-Keun
authors.initials: YK
authors.lastname: Kim
authors.forename: Sang-Heon
authors.initials: SH
authors.lastname: Cho
authors.forename: Yeong-Wook
authors.initials: YW
authors.lastname: Song
authors.forename: Dong-Chul
authors.initials: DC
authors.lastname: Choi
authors.forename: Kyung-Up
authors.initials: KU
authors.lastname: Min
authors.forename: You-Young
authors.initials: YY
authors.lastname: Kim
mesh_terms: D000328:Adult; D001157:Arterial Occlusive Diseases / Q000175:diagnosis* / Q000209:etiology; D023201:CD40 Ligand / Q000032:analysis; D003490:Cyanosis / Q000209:etiology; D003937:Diagnosis, Differential; D004802:Eosinophilia / Q000175:diagnosis* / Q000209:etiology; D005260:Female; D005734:Gangrene / Q000209:etiology; D006801:Humans; D017681:Hypereosinophilic Syndrome / Q000097:blood / Q000150:complications / Q000175:diagnosis*; D007150:Immunohistochemistry; D016491:Peripheral Vascular Diseases / Q000175:diagnosis* / Q000209:etiology; D012867:Skin / Q000737:chemistry / Q000473:pathology; D014409:Tumor Necrosis Factor-alpha / Q000378:metabolism; D014657:Vasculitis / Q000175:diagnosis* / Q000209:etiology
chemical_list: D014409:Tumor Necrosis Factor-alpha; D023201:CD40 Ligand