Published online Oct 6, 2021. doi: 10.12998/wjcc.v9.i28.8571
Peer-review started: May 17, 2021
First decision: June 24, 2021
Revised: July 8, 2021
Accepted: July 28, 2021
Article in press: July 28, 2021
Published online: October 6, 2021
Hypereosinophilia (HE) is defined as a peripheral blood eosinophil count of > 1.5 × 109/L and may be associated with tissue damage. The clinical presentations of HE vary; however, myocardial fibrosis and thrombosis can threaten the lives of patients with sustained eosinophilia. Cerebral venous sinus thrombosis (CVST) in the setting of eosinophil-related diseases has seldom been reported. Here, we review the literature on HE with CVST to increase knowledge and encourage early diagnosis.
A previously healthy 41-year-old man was admitted to hospital with diarrhea and abdominal pain. He was treated with antibiotics for suspected acute colitis. Three days later, he experienced headache and vomiting. Brain computed tomography (CT) revealed thrombosis of the left jugular vein to the left transverse sinus vein. Platelet (PLT) count decreased to 60 × 1012/L, and absolute eosinophil count (AEC) increased to 2.41 × 109/L. He was treated with low-molecular-weight heparin. PLT count progressively decreased to 14 × 109/L, and we terminated anticoagulation and performed PLT transfusion. Six days after admission, he complained of a worsening headache. Brain CT revealed right temporal lobe and left centrum semiovale intracerebral hemorrhage, and AEC increased to 7.65 × 109/L. We used prednisolone for HE. The level of consciousness decreased, so emergency hematoma removal and decompressive craniectomy for right cerebral hemorrhage were performed. The patient was alert 2 d after surgery. He was treated with anticoagulation again 2 wk after surgery. Corticosteroids were gradually tapered without any symptomatic recurrence or abnormal laboratory findings.
HE can induce CVST, and we need to focus on eosinophil counts in patients with CVST.
Core Tip: Thromboembolism is a rare but serious complication of hypereosinophilia (HE). We report a 41-year-old man who presented with colitis, cerebral venous sinus thrombosis (CVST), and intracerebral hemorrhage caused by HE. Blood eosinophil count decreased quickly after corticosteroid therapy, and CVST caused headache, which improved after anticoagulation therapy. Good clinical outcomes were observed during a 6-mo follow-up period. We conclude that HE can induce CVST, and we need to focus on eosinophil counts in patients with CVST. Corticosteroids are a useful first-line therapy for platelet-derived growth factor receptor A/B-negative HE.