Rapidly evolving asymptomatic eosinophilia in a patient with lung adenocarcinoma causes cognitive disturbance and respiratory insufficiency: Case report

Abstract

Paraneoplastic eosinophilia is an unusual manifestation that usually remains asymptomatic. In this report, we presented the case of an 82-year-old patient with poorly differentiated lung adenocarcinoma and asymptomatic eosinophilia. The patient’s condition worsened rapidly over a week, with episodes of cognitive disturbance, shortness of breath and acute kidney dysfunction. These symptoms were associated with a 4-fold increase in circulating eosinophil counts. The poor condition hindered further anticancer treatment. Treatment of the eosinophilia with corticosteroids and hydroxyurea significantly reduced circulating eosinophil counts to below the initial levels. Results of this case report suggested that lung cancer patients should be monitored closely for rapidly worsening symptoms of cognitive disturbance and respiratory insufficiency as signs of life-threatening asymptomatic eosinophilia, in order to initiate corticosteroid treatment.

Metastatic Lung Adenocarcinoma Presenting with Hypereosinophilia

“…Unlike primary eosinophilia, which responds to steroids, paraneoplastic eosinophilia can be resistant. Sometimes a combination of steroids and hydroxyurea can increase the response rate [ 6 ]. However, the cornerstone of management includes treating the malignancy by either chemotherapy or surgery [ 4 , 9 ].…”

“…However, solid tumors can cause eosinophilia in some cases [ 5 ]. The incidence of eosinophilia in malignant tumors is estimated to be approximately 1% [ 6 ]. Eosinophilia presentation can be silent and life-threatening.…”

Hypereosinophilia in Solid Tumors—Case Report and Clinical Review

“…The mechanism contributing to eosinophilia in malignant diseases has not yet been fully determined. It has been suggested that three cytokines, namely interleukin-3 (IL-3), interleukin-5 (IL-5), and granulocyte-macrophage colony-stimulating factor (GM-CSF), may act as a potential eosinophilopoietin polypeptide ( 6 , 13 , 15 , 24 , 25 , 29 , 35 , 50 , 51 , 76 , 82 , 83 ). Unfortunately, in our patient, neither the level of IL-5, IL-3, and GM-CSF in serum was determined nor immunohistochemical staining with indicated antibodies was performed.…”

“…Among the one hundred previously reported and analyzed by us cases of TABE, the death of 68 patients was reported ( 4 , 7 , 8 , 10 – 14 , 16 – 22 , 24 – 28 , 30 , 32 , 34 – 37 , 39 , 44 , 46 – 51 , 53 – 60 , 65 , 67 – 69 , 71 , 72 , 74 – 76 , 82 – 88 , 94 – 96 ). About 90% of the deaths occurred within one year after the diagnosis of paraneoplastic hypereosinophilia.…”

Management of Hypereosinophilic Syndromes

“…24 If treatment fails (eg, metastatic lung cancer refractory to chemotherapy), management of the HES with corticosteroids may improve the patient's quality of life. 28 The approach to drug allergy depends on the clinical presentation and the complexity of comorbidities and their treatment. Patients with severe, potentially life-threatening complications of HE, such as DRESS syndrome, cardiomyopathy, or pulmonary hypersensitivity, should be hospitalized for surveillance and treatment.…”