MRI findings of muscle involvement in idiopathic hypereosinophilic syndrome

Abstract

A 40-year-old white man presented with fever, muscle pain, skin nodules and persistent hypereosinophilia over a period of 1 year. In addition, he had ventricular arrhythmias with episodes of tachycardia. Besides a lack of response to antiparasitic therapy, laboratory and pathological data excluded the diagnosis of trichinosis or any other parasitic infection. The patient's course of the disease over the previous 1(1)/2 years was compatible with hypereosinophilic syndrome. In a muscle biopsy several eosinophilic perivascular and leucocytic intravascular infiltrates were found, indicative of muscle involvement by the disease. This is a report on the MRI findings of muscle involvement in idiopathic hypereosinophilic syndrome.

Chronic eosinophilic perimyositis with persistent myalgias

“…24, 25 Magnetic resonance imaging may show diffuse enhancement of affected muscle in both myositis and perimyositis. 8, 24 Because of the infrequency of this disorder, its natural history is not well understood. Neuromuscular symptoms in eosinophilic disorders, including eosinophilic perimyositis, usually respond well to nonsteroidal anti‐inflammatory drugs and corticosteroid medications (80% in EMS), 4, 6, 7, 9, 14, 16, 17, 22, 24 and only rarely is it necessary to resort to a more aggressive approach with immunosuppressive medications (methotrexate).…”

The eosinophilias, including the idiopathic hypereosinophilic syndrome

“…Anti‐parasite treatment, in the absence of a confirmed diagnosis of parasite infection, has also been suggested as an effective means of eliminating parasites as a cause of hypereosinophilia in travellers to the tropics (Molinier et al , 1998). In other patients, anti‐parasite treatment has also been given before HES is considered as a diagnosis (Hundt et al , 1999). In the patient reported by Arango (1998), blood eosinophilia and splenomegaly did not resolve until a second course of thiabendazole treatment was given for presumed Toxocara canis infection.…”

“…Raynaud's phenomenon (Layzer et al , 1977) and digital necrosis (Takekawa et al , 1992) have also been reported. Hundt et al (1999) performed muscle biopsy in a patient with HES presenting with muscle pain. The biopsy showed perivascular eosinophilic infiltrates in involved muscles, indicating the significant role eosinophil infiltration plays in the pathology of end‐organ damage.…”

Revisiting idiopathic eosinophilic myositis: towards a clinical-pathological continuum from the muscle to the fascia and skin

“…The subgroup analysis identified that EMF patients frequently presented with general physical deterioration, hypereosinophilia and elevated CRP compared with other subgroups, thus potentially fulfilling the criteria for idiopathic hypereosinophilic syndrome (HES) [ 18 ]. The latter is defined as a disease with sustained peripheral blood hypereosinophilia and hypereosinophilia-related organ damage in the absence of any known cause of eosinophilia such as myeloid/lymphoid neoplasms or secondary causes such as parasitic infection [ 19 , 20 ].…”