Déjà vu.
Aashish Omprakash Agrawal, Aditi Sanjiv Patankar, Rohini Samant
✦ AI-curated · Sources linked
Case in brief
A male in his mid-20s presented with fever, purpuric rash, neuropathy, marked eosinophilia, hepatic dysfunction, and extensive multisystem thrombosis. Initial biopsy indicated eosinophilic infiltration without vasculitis, leading to a diagnosis of hypereosinophilic syndrome (HES). After achieving remission with corticosteroids and anticoagulation, he relapsed five years later with eosinophilic vasculitis, resulting in reclassification to ANCA-negative eosinophilic granulomatosis with polyangiitis (EGPA). Treatment with corticosteroids, rituximab, and anticoagulation led to sustained remission over 36 months.
Diagnostic / clinical pearl
This case underscores the diagnostic overlap between hypereosinophilic syndrome and eosinophilic granulomatosis with polyangiitis, particularly in ANCA-negative presentations.
Why it matters
Long-term follow-up and reassessment of diagnosis are crucial, as evolving vasculitis may necessitate changes in immunosuppressive therapy.