Hypereosinophilic syndrome (HES) is definitely a rare entity of unfamiliar etiology
May 1, 2017
Hypereosinophilic syndrome (HES) is definitely a rare entity of unfamiliar etiology that may cause a multitude of problems from pores and skin rash to organ failure due to eosinophil infiltrate of cells. related to hypereosinophilia. Keywords: Pregnancy Hypereosinophilic Syndrome Intro Hypereosinophilic syndrome (HES) encompasses a wide range of medical manifestations and its course may vary from relatively indolent to aggressive and rapidly fatal.1 Analysis as defined by Chusid et al 2 includes 1) peripheral blood eosinophil count of greater than 1.5×109/L for 6 months or longer 2 evidence of organ involvement as a result excluding benign eosinophilia and 3) an absence of other causes of eosinophilia such as parasitic infections allergy E-7010 malignancy and collagen vascular disease. Multiple cytokines stimulate eosinophil production including interleukins 3 and 5 and granulocyte-macrophage colony-stimulating element. 1 Treatment of HES varies widely. Steroids are the most common initial treatment with good control of the disease and connected symptoms and indications in the majority of patients. Long term steroid use is E-7010 definitely associated however with undesirable side effects and additional medications are then utilized including hydroxyurea interferon and imatinib. 1 For more than a century clinical observations have identified the ameliorating effect of pregnancy on inflammatory disorders in such individuals.3 A number of factors have been suggested as immunomodulating factors capable of modifying inflammatory disorders during pregnancy including cortisol progesterone and pregnancy associated a2-glycoprotein. 3 In a healthy subject pregnancy is accompanied by leukocytosis and a decrease in circulating eosinophils; eosinopenia is statistically significant.4 These changes may symbolize increased adrenal cortical activity since during pregnancy physiologic increase in pituitary activity results in increased production of adrenal corticotropic hormone (ACTH) which stimulates the adrenal cortex to secrete more steroids.5 Interestingly it has been reported that a component of maternal ACTH in pregnancy isn’t just of pituitary origin but also of placental origin.6 The placenta releases ACTH autonomously not subject to opinions control.7 Due to these physiologic mechanisms associated with pregnancy it is of interest to describe an effect of pregnancy on hypereosinophilia and associated signs and symptoms in individuals with founded HES. Review of the available English literature exposed a number of case reports of a pregnancy associated with an acute eosinophilic disorders with pulmonary involvement like a main problem. These disorders include pulmonary eosinophilic granuloma/eosinophilic granulomatosis of lungs 8 9 idiopathic eosinophilic pneumonia 10 Churg-Strauss syndrome 11 and eosinophilia-associated hypermeability syndrome E-7010 (with pericardial and pleural effusions and ascites).12 One case explained an elevation of blood eosinophils in a newborn in a patient with HES.13 We found only one case report of a pregnancy in a patient with established HES in whom blood eosinophil count during the pregnancy was monitored and reported.14 The case involved a 22-year-old woman with founded hypereosinophilia (preceding pregnancy for 14 months) and associated pores and skin rash and itching.14 Daily dose of prednisone (15mg) controlled the symptoms well. The analysis of HES was made by exclusion of parasitic collagen-vascular and sensitive diseases. The patient presented at 11 weeks gestation for antenatal assessment and ultrasound exam showed a twin pregnancy. The WBC was 29.2 × 109/L with >70% Mctp1 eosinophils (absolute eosinophil count ~21 × 109/L. A rise of blood eosinophils to 35 × 109/L required augmentation of a daily prednisone dose to 75mg for a period of 5 weeks. This was then reduced in methods over 4 weeks to a daily maintenance dose of 25mg. Despite monitoring E-7010 the patient closely she offered at 30 weeks gestation with premature rupture of membranes resulting in Cesarean delivery under general anesthesia. The two male infants did well; neither showed hypereosinophilia within their first six months of existence. At 10 weeks postpartum the mother’s WBC count stabilized at 15-20 × 109/L with.