Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jun 26, 2022; 10(18): 6325-6332
Published online Jun 26, 2022. doi: 10.12998/wjcc.v10.i18.6325
Pneumonia and seizures due to hypereosinophilic syndrome—organ damage and eosinophilia without synchronisation: A case report
Tetsuro Ishida, Tomonori Murayama, Seiju Kobayashi
Tetsuro Ishida, Department of Psychiatry, Hokujinkai Ishibashi Hospital, Otaru 047-8585, Japan
Tomonori Murayama, Department of Psychiatry, Kushiro Red Cross Hospital, Kushiro 085-8512, Japan
Seiju Kobayashi, Department of Psychiatry, Shinyukai Nakae Hospital, Sapporo 001-0022, Japan
Author contributions: Ishida T was the patient's primary care physician and contributed to the literature review and manuscript preparation; Murayama T and Kobayashi S reviewed the literature and contributed to the preparation of the manuscript; and All authors gave their approval for the final version to be submitted.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflicts 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:
Corresponding author: Tetsuro Ishida, MD, Chief Doctor, Department of Psychiatry, Hokujinkai Ishibashi Hospital, 3-7-7 Nagahashi, Otaru 047-8585, Japan.
Received: February 3, 2022
Peer-review started: February 3, 2022
First decision: March 23, 2022
Revised: March 29, 2022
Accepted: April 30, 2022
Article in press: April 30, 2022
Published online: June 26, 2022

Hypereosinophilic syndrome (HES) is a condition characterized by increased eosinophil proliferation in the bone marrow, as well as tissue eosinophilia, often causing organ damage. The cause of the disease is unknown. Initial symptoms include fatigue, cough, shortness of breath, myalgia, angioedema, fever, and pneumonia. In addition to the respiratory symptoms, damage to the central nervous system can lead to severe seizures. Here, we report a case with pneumonia and complex partial seizures secondary to HES.


A 94-year-old woman was admitted to our hospital for heart failure and bloody stools. After admission, she also showed symptoms of pneumonia. Non-contrast computed tomography of the chest showed pleural effusion and infiltrative shadows. Lower gastrointestinal endoscopy showed multiple ulcers in the sigmoid colon. Blood analyses showed marked eosinophilia (eosinophils 1760/mm3, total leukocytes 6850/mm3). Initial treatment with furosemide 20 mg/d and prednisolone 25 mg/d relieved these symptoms. However, the patient subsequently experienced localised epileptic seizures characterized by bilateral eyelid twitching and eyes rolling upwards, without generalized convulsions, and respiratory arrest occurred. Electroencephalography showed spikes and waves. Non-contrast magnetic resonance imaging of the brain showed extensive periventricular hyperintensity. With administration of levetiracetam 1000 mg/d the epileptic seizures disappeared. However, the patient’s consciousness remained impaired, and her pneumonia worsened again. Two weeks later, she died of pneumonia.


HES symptoms are variable and atypical, and the level and timing of eosinophilia and organ damage are often discordant.

Keywords: Case report, Hypereosinophilic syndrome, Pneumonia, Seizures, Prednisolone, Levetiracetam

Core Tip: Although there are diagnostic criteria for hypereosinophilic syndrome, the various degrees of organ damage and hypereosinophilia often make diagnosis difficult in clinical practice. In addition, the organ damage and blood changes do not always occur concurrently. Therefore, clinicians must consider many differential diagnoses, especially when patients present with atypical symptoms and disease course. Early initiation of treatment is no less important than an accurate diagnosis, and the balance between the two should be considered according to the patient's condition as well as the level and quality of medical resources available at the hospital.