Idiopathic hypereosinophilic syndrome with infiltration of cerebrospinal fluid by immature eosinophils: a case report and literature review.
BACKGROUND
Idiopathic hypereosinophilic syndrome is characterized by persistent hypereosinophilia with end organ damage and no definite underlying cause. It has been recognized that eosinophils can induce varying degrees of neural damage. There are only a few reports in the literature regarding CSF by eosinophils, and the relationship between hypereosinophilic syndrome and eosinophilic leukemia remains unclear.


METHODS
We report a case of IHS with CSF infiltration by immature eosinophils and significant subdural effusion with underlying brain parenchyma compression. He was treated by inserting a subdural-peritoneal shunt with improvement. Respiratory distress and pulmonary infiltration with eosinophils developed. Imatinib mesylate (Gleevec) was added with improvement, and subsequent CSF study showed normalization of CSF cytology analysis. However, re-collection of subdural fluid developed later and resulted in consciousness disturbance, and the patient died thereafter.


CONCLUSIONS
Idiopathic hypereosinophilic syndrome remains a serious condition with a poor prognosis for most patients. Cerebrospinal fluid infiltration by immature eosinophils is a rare condition in IHS and may lead to poor prognosis, as observed in this patient, despite improved medical management (steroid and imatinib mesylate) and adequate surgical shunting for the subdural effusion.
Chou
Chiang-Wei
CW
Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taiwan School of Medicine, National Yang Ming University, Taipei 112, Taiwan.
Hsu
Sanford P C
SP
Chen
Ming-Teh
MT
Chen
Min-Hsiung
MH
Shih
Yang-Hsin
YH
Lee
Liang-Shong
LS
Lin
Chun-Fu
CF
D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use; D001549:Benzamides; D002557:Cerebrospinal Fluid Shunts; D004804:Eosinophils / Q000473:pathology*; D017809:Fatal Outcome; D006801:Humans; D017681:Hypereosinophilic Syndrome / Q000134:cerebrospinal fluid* / Q000503:physiopathology*; D000068877:Imatinib Mesylate; D019586:Intracranial Hypertension / Q000209:etiology / Q000503:physiopathology*; D008297:Male; D010879:Piperazines / Q000627:therapeutic use; D011379:Prognosis; D011743:Pyrimidines / Q000627:therapeutic use; D013353:Subdural Effusion / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology*; D013355:Subdural Space / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology*; D014057:Tomography, X-Ray Computed; D017211:Treatment Failure
D000970:Antineoplastic Agents; D001549:Benzamides; D010879:Piperazines; D011743:Pyrimidines; D000068877:Imatinib Mesylate