Extensive Digital Gangrene Without Evidence of Large-vessel Occlusion in Hypereosinophilic Syndrome

Kim, Taegyun; Kim, Mi Ri; Kim, Jong Hoon; Jee, Hyungjoong; Kim, Soo Chan

doi:10.2340/00015555-1044

Cited by 8 publications

(8 citation statements)

References 14 publications

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“…After removing duplicate and redundant articles, 25 papers were included in the present study for the final review and analysis. A thorough reading of these articles yielded a total of 32 cases of idiopathic HES with cutaneous involvement 5–29. A comprehensive review of these case reports indicated a slight male predominance (male, n = 19; female, n = 13).…”

Section: Discussionmentioning

confidence: 99%

Idiopathic hypereosinophilic syndrome with cutaneous involvement: a comparative review of 32 cases

Inayat¹,

O’Neill

Zafar

et al. 2018

BMJ Case Rep

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Although idiopathic hypereosinophilic syndrome (HES) is uncommon, we studied the clinical characteristics of this disorder in patients with cutaneous involvement. We chronicle the case of a patient with diffuse skin rash due to idiopathic HES from our clinical experience. Furthermore, a systematic literature search of the medical databases PubMed and Google Scholar was conducted. A total of 32 cases fulfilled the inclusion criteria. The data on patients’ characteristics, epidemiology, clinical features, diagnosis, treatment and outcome were collected and analysed. This review illustrates that physicians should maintain a high index of clinical suspicion for idiopathic HES in patients presenting with dermatological lesions and hypereosinophilia, without an obvious cause. Randomised clinical trials are warranted to outline a generalised and efficient therapeutic approach in these patients. Additionally, this paper highlights the need for population-based studies to delineate the magnitude and scope of this association.

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Section: Discussionmentioning

confidence: 99%

Idiopathic hypereosinophilic syndrome with cutaneous involvement: a comparative review of 32 cases

Inayat¹,

O’Neill

Zafar

et al. 2018

BMJ Case Rep

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“…As also documented in this case, skin abnormalities are commonly the presenting feature of HES. There is a particularly high prevalence (up to 94%) of skin involvement in CD3 − CD4 + L-HES patients 1, 2, 3, 4, 5, 6. Unlike the male predominance in the M-HES population, L-HES cases are evenly divided between male and female patients.…”

Section: Discussionmentioning

confidence: 98%

“…Thrombosis is a complication that can be seen in HES accompanied by eosinophilic vasculitis, which in combination with digital gangrene has sporadically been reported in patients with HES 3, 4, 5, 6. The underlying pathomechanism for vascular inflammation and thrombus formation or occlusion is obscure in HES.…”

Section: Discussionmentioning

confidence: 99%

“…Diagnostic criteria for HES include the following: peripheral blood eosinophilia with eosinophil counts >1500/μL for at least 6 months; no evidence of parasitic, allergic, or other known causes of eosinophilia; presumptive signs; and symptoms of multiple organ involvement. The most common cutaneous features of HES are erythematous pruritic papules and nodules, angioedema, and urticarial plaques 1, 2, 3. We here describe a patient with HES presenting with cutaneous eosinophilic vasculitis and severe vascular damage resulting in digital gangrene.…”

mentioning

confidence: 92%

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Hypereosinophilic syndrome complicated by severe vascular damage and gangrene

Gambichler

Kröger

Tannapfel

et al. 2019

Journal of Vascular Surgery Cases, Innovations and Techniques

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Hypereosinophilic syndrome (HES) is a complex multisystem disease characterized by sustained overproduction of eosinophils. A 40-year-old woman presented with digital ischemia and gangrene on her distal fingers and toes. We diagnosed HES on the basis of marked eosinophilia, accumulation of eosinophils in organs, and cutaneous eosinophilic vasculitis after having excluded all differential diagnoses. On digital subtraction angiography, occlusion of several arteries of both lower legs was noted. HES may be associated with severe vascular damage including gangrene. The occurrence of digital gangrene is a differential diagnostic challenge that should also include investigations of blood parameters, such as eosinophils.

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“…Thus, we consider that the present case-in which the AEC was >1,500/mm 3 without apparent causes-can be regarded as HES. Previous studies have demonstrated that HES can cause digital ischemia either by microthrombi (62,63), or by the occlusion of intermediate to large-sized arteries (3, 4, 6, 11). Notably, a 28-year-old Japanese man with HES presenting with eosinophilic cellulitis, Raynaud's phenomenon, digital gangrene, and JTA was described by Ito et al, who proposed that JTAE may be one of the features of HES (10).…”

Section: Discussionmentioning

confidence: 99%

Development of Eosinophilic Temporal Arteritis and Digital Ischemia in a Patient with Hypereosinophilic Syndrome

et al. 2020

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We describe a case of eosinophilic temporal arteritis in a 61-year-old woman with hypereosinophilic syndrome, who developed subcutaneous nodules in the temporal areas and digital cyanosis with small nodules on the sides of her fingers. Ultrasound revealed occlusion and corkscrew-like changes of the temporal and digital arteries, respectively. Temporal artery biopsy revealed eosinophilic vasculitis without giant cell formation. Angiography showed occlusion of the ulnar and digital arteries. Administration of low-dose corticosteroid improved the temporal artery swelling and digital cyanosis. More reports of similar cases are required to characterize this type of non-giant cell eosinophilic vasculitis that affects the peripheral arteries.

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Extensive Digital Gangrene Without Evidence of Large-vessel Occlusion in Hypereosinophilic Syndrome

Cited by 8 publications

References 14 publications

Idiopathic hypereosinophilic syndrome with cutaneous involvement: a comparative review of 32 cases

Idiopathic hypereosinophilic syndrome with cutaneous involvement: a comparative review of 32 cases

Hypereosinophilic syndrome complicated by severe vascular damage and gangrene

Development of Eosinophilic Temporal Arteritis and Digital Ischemia in a Patient with Hypereosinophilic Syndrome

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