Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Apr 16, 2022; 10(11): 3547-3552
Published online Apr 16, 2022. doi: 10.12998/wjcc.v10.i11.3547
Hypereosinophilic syndrome presenting as acute ischemic stroke, myocardial infarction, and arterial involvement: A case report
Ran-Ran Sun, Tuan-Zhi Chen, Min Meng
Ran-Ran Sun, Tuan-Zhi Chen, Department of Neurology, Liaocheng People’s Hospital, Liaocheng 252000, Shandong Province, China
Min Meng, Department of Central Laboratory, Liaocheng People’s Hospital, Liaocheng 252000, Shandong Province, China
Author contributions: Sun RR and Chen TZ evaluated and managed the patient; Sun RR and Meng M prepared the figures; Meng M wrote and edited the manuscript; all authors read and approved the final manuscript.
Informed consent statement: Informed written consent was obtained from the patients for the publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Min Meng, MS, Doctor, Department of Central Laboratory, Liaocheng People’s Hospital, No. 67 Dongchang West Road, Liaocheng 252000, Shandong Province, China. mengmin2011@126.com
Received: October 30, 2021
Peer-review started: October 30, 2021
First decision: December 27, 2021
Revised: January 6, 2022
Accepted: February 27, 2022
Article in press: February 27, 2022
Published online: April 16, 2022
Processing time: 160 Days and 2.8 Hours
Abstract
BACKGROUND

Simultaneous cerebral and myocardial infarction with arterial involvement has not been reported in hypereosinophilic syndrome (HES). Here, we report a patient with HES that was also associated with acute ischemic stroke, myocardial infarction, and arterial involvement of the left common carotid artery, vertebral arteries, posterior cerebral artery, and coronary artery.

CASE SUMMARY

A 64-year-old male patient was admitted with headache and right lower extremity weakness. Laboratory tests indicated eosinophilia. Brain magnetic resonance imaging (MRI) showed bilateral and multiple acute infarcts in the border zones. Electrocardiography revealed that T wave was inverted and that the concentration of troponin I was significantly elevated above normal levels. Cardiac echocardiography showed an ejection fraction of 69% with mitral and tricuspid mild regurgitation. Computed tomography angiography detected multiple and localized instances of mild stenosis in the left common carotid artery bifurcation, bilateral vertebral arteries (V5 segment), and the posterior cerebral artery (P2 segment). These were observed together with multiple non-calcified and mixed plaques as well as luminal stenosis in the left circumflex artery, left anterior descending artery, and right coronary artery. The patient was treated with oral methylprednisolone and clopidogrel, after which the absolute eosinophil count fell rapidly to a normal level. After one month, a second brain MRI showed a partial reduction in the size and number of the lesions.

CONCLUSION

HES can masquerade as ischemic stroke, myocardial infarction, and arterial vascular involvement. The patient reported here recovered very quickly when his eosinophil blood count returned to normal. Early diagnosis and rapid reduction of eosinophils may lead to a good prognosis.

Keywords: Hypereosinophilic syndrome; Ischemic stroke; Myocardial infarction; Arterial involvement; Case report

Core Tip: Hypereosinophilic syndrome (HES) is characterized by unexplained eosinophilia in the blood and tissues. Neurologic and cardiac involvement in patients with HES is common and variable. Eosinophil-mediated arterial vascular involvement is a rare manifestation of HES. This rare case of HES was accompanied by acute ischemic stroke, myocardial infarction and arterial vascular involvement. Early diagnosis and rapid reduction of eosinophils may lead to a good prognosis.