title: Effect of cyclosporine on lymphocytic variant hypereosinophilic syndrome.
abstract: Lymphocytic variant hypereosinophilic syndromes (L-HES) is thought to be caused by the over-production of interleukin (IL)-5 by type 2 helper cells, which leads to reactive eosinophil expansion and activation. Here we demonstrate the effect of cyclosporine in a patient with L-HES. In the present case, the surface markers of cells from resected lymph nodes or peripheral blood were analyzed by flow cytometry. Serum concentrations of IL-4, IL-5, and IL-8 were measured using an enzyme-linked immunosorbent assay. Methyl-prednisolone pulse therapy followed by the administration of 150 mg/day of cyclosporine combined with 15 mg/day of prednisolone ameliorated eosinophilia. However, abnormal CD3-CD4+ T cell clones remained even when the eosinophil count recovered to normal levels. An elevated IL-8 level was observed only when eosinophils increased. On the other hand, serum IL-4 and IL-5 levels were under detectable limits during the course. Cyclosporine was effective in decreasing the eosinophil count without the elimination of abnormal T cell clones in the present case. Cytotoxic agents may be necessary to cure this serious disease. Moreover, target therapy for IL-8 may be a new strategy for L-HES with high IL-8 and low IL-5 concentrations.
authors.affiliation: Department of Internal Medicine, Hyogo Prefectural Tsukaguchi Hospital, Japan. rtabata@hp.pref.hyogo.jp
authors.forename: Rie
authors.initials: R
authors.lastname: Tabata
authors.forename: Chiharu
authors.initials: C
authors.lastname: Tabata
authors.forename: Yuki
authors.initials: Y
authors.lastname: Katashima
authors.forename: Ryoji
authors.initials: R
authors.lastname: Yasumizu
mesh_terms: D018791:CD4 Lymphocyte Count; D015496:CD4-Positive T-Lymphocytes / Q000187:drug effects* / Q000276:immunology; D016572:Cyclosporine / Q000008:administration & dosage / Q000627:therapeutic use*; D004804:Eosinophils / Q000166:cytology; D005434:Flow Cytometry; D006801:Humans; D017681:Hypereosinophilic Syndrome / Q000097:blood* / Q000175:diagnosis / Q000188:drug therapy* / Q000276:immunology; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D007378:Interleukins / Q000097:blood*; D008198:Lymph Nodes / Q000276:immunology; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents; D007378:Interleukins; D016572:Cyclosporine