Hypereosinophilic syndrome complicated by disseminated intravascular coagulation (DIC), deep venous thrombosis and pulmonary embolism

Miyagi, Junko; Ichimiya, Michiko; Ozaki, Keiji; Goto, Tetsuya; Fujino, Osamu; Nagata, Junnichi; Hiasa, Yoshikazu

doi:10.2169/naika.93.364

Cited by 3 publications

(4 citation statements)

References 6 publications

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“…Shrinkage of the gastric cancer site following chemotherapy then resulted in the suppression of IL-5, leading to a normalized level of serum eosinophil granulocytes. In addition, hypereosinophilia is often associated with DIC (20)(21)(22)(23)(24)(25)(26)(27). The mechanisms underlying DIC associated with eosinophilia are not fully understood; however, the granule proteins released by eosinophils, such as ECP, are thought to cause hypercoagulation (20).…”

Section: Discussionmentioning

confidence: 99%

Prominent Hypereosinophilia with Disseminated Intravascular Coagulation as an Unusual Presentation of Advanced Gastric Cancer

et al. 2014

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A 78-year-old woman was admitted to our hospital complaining of anorexia and purpura of the extremities. She presented with prominent peripheral eosinophilia and disseminated intravascular coagulation (DIC). Despite receiving intensive therapy for DIC, her illness worsened. Esophagogastroduodenoscopy revealed advanced gastric cancer (AGC), and a bone marrow biopsy led to a diagnosis of disseminated carcinomatosis of the bone marrow caused by AGC. We initiated combination chemotherapy with S-1 and cisplatin, which lead to a significant improvement of the DIC and eosinophilia, and the patient was finally discharged. The primary symptoms of DIC and eosinophilia were both considered to be caused by AGC, and we successfully treated the patient's critical condition.

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Section: Discussionmentioning

confidence: 99%

Prominent Hypereosinophilia with Disseminated Intravascular Coagulation as an Unusual Presentation of Advanced Gastric Cancer

et al. 2014

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“…Hypereosinophilia complicated with acquired hemophilia has been reported only once previously in the literature [23]. In our patient, DIC, a frequent complication of HES [9,14,16-18], possibly exacerbated the bleeding tendency. These findings remain to be generalized to other cases of HES-derived coagulopathy.…”

Section: Discussionmentioning

confidence: 56%

“…In contrast, the myeloproliferative variant (M-HES) is characterized by emergence of fusion genes (for example, PDGFRa , PDGFRb , and FGFR1 ) originating from a chromosomal translocation in 4q12, 5q33, and 8p11, respectively [8]. HES affects not only diverse organs, but also causes thrombotic occlusion in arteries [9,10], veins [11-14], and capillaries [15]. In addition, patients with HES present with coagulation abnormalities, especially disseminated intravascular coagulation (DIC), possibly due to this thrombotic tendency [9,14,16-18].…”

Section: Introductionmentioning

confidence: 99%

“…HES affects not only diverse organs, but also causes thrombotic occlusion in arteries [9,10], veins [11-14], and capillaries [15]. In addition, patients with HES present with coagulation abnormalities, especially disseminated intravascular coagulation (DIC), possibly due to this thrombotic tendency [9,14,16-18]. However, the mechanism of HES-derived coagulation abnormality is not fully understood.…”

Section: Introductionmentioning

confidence: 99%

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A patient with hypereosinophilic syndrome that manifested with acquired hemophilia and elevated IgG4: a case report

2012

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IntroductionHypereosinophilic syndrome is defined as a prolonged state (more than six months) of eosinophilia (greater than 1500 cells/μL), without an apparent etiology and with end-organ damage. Hypereosinophilic syndrome can cause coagulation abnormalities. Among hypereosinophilic syndrome types, the lymphocytic variant (lymphocytic hypereosinophilic syndrome) is derived from a monoclonal proliferation of T lymphocytes. Here, we describe the case of a patient with lymphocytic hypereosinophilic syndrome who presented with a coagulation abnormality. To the best of our knowledge, this is the first such report including a detailed clinical picture and temporal cytokine profile.Case presentationA 77-year-old Japanese man presented to our facility with massive hematuria and hypereosinophilia (greater than 2600 cells/μl). His eosinophilia first appeared five years earlier when he developed femoral artery occlusion. He manifested with multiple hematomas and prolonged activated partial thromboplastin time. His IgG4 level was remarkably elevated (greater than 2000 mg/dL). Polymerase chain reaction tests of peripheral blood and bone marrow identified lymphocytic hypereosinophilic syndrome. His prolonged activated partial thromboplastin time was found to be due to acquired hemophilia. Glucocorticoids suppressed both the hypereosinophilia and coagulation abnormality. However, tapering of glucocorticoids led to a relapse of the coagulation abnormality alone, without eosinophilia. Tumor necrosis factor α, interleukin-5, and/or eotaxin-3 may have caused the hypereosinophilia, and interleukin-10 was correlated with the coagulation abnormality.ConclusionsTo the best of our knowledge, this is the first case in which lymphocytic hypereosinophilic syndrome and IgG4-related disease have overlapped. In addition, our patient is only the second case of hypereosinophilic disease that manifested with acquired hemophilia. Our patient relapsed with the coagulation abnormality alone, without eosinophilia. This report shows that the link between eosinophilia, IgG4, and clinical manifestations is not simple and provides useful insight into the immunopathology of hypereosinophilic syndrome and IgG4-related disease.

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A Case of Hypereosinophilic Syndrome Presenting With Multiorgan Infarctions Associated With Disseminated Intravascular Coagulation

Park

Kim

et al. 2012

Allergy Asthma Immunol Res

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Thromboembolism is one of the most critical complications of hypereosinophilic syndrome (HES). We report here a case of multi-organ infarctions related to HES. A 23-year-old woman was referred to our hospital with hemoptysis. Not only pulmonary, but also renal and splenic infarctions were detected on computed tomography images. Blood tests showed profound peripheral eosinophilia. She was diagnosed with HES with disseminated intravascular coagulation (DIC). We initiated infusion of corticosteroids, which effectively suppressed peripheral eosinophilia. However, consumptive coagulopathy did not improve and intracerebral hemorrhage related to thrombosis then developed. Addition of interferon-alpha resulted in the correction of the DIC associated with HES.

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Hypereosinophilic syndrome complicated by disseminated intravascular coagulation (DIC), deep venous thrombosis and pulmonary embolism

Cited by 3 publications

References 6 publications

Prominent Hypereosinophilia with Disseminated Intravascular Coagulation as an Unusual Presentation of Advanced Gastric Cancer

Prominent Hypereosinophilia with Disseminated Intravascular Coagulation as an Unusual Presentation of Advanced Gastric Cancer

A patient with hypereosinophilic syndrome that manifested with acquired hemophilia and elevated IgG4: a case report

A Case of Hypereosinophilic Syndrome Presenting With Multiorgan Infarctions Associated With Disseminated Intravascular Coagulation

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