Acute Respiratory Distress Syndrome Caused by Hypereosinophilic Syndrome. A case report Ryota Kurose 1 , Akihito Ueda 1 , Shigeru Nakada 1 , Yuko Katsuta 1 , Kenji Sakata 1 , Hiroshi Matsumoto 1 , Tadayoshi Takekoshi 1 , Katsuaki Sato 2 1Department of Internal Medicine, Wajima City Hospital 2Department of Cytopathology, Kanazawa University, Graduate School of Medicine Keyword: 好酸球増多症候群 , ARDS , hypereosinophilic syndrome , ARDS pp.537-543
Published Date 2004/5/1
DOI https://doi.org/10.11477/mf.1404100306
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 Hypereosinophilic syndrome(HES) is a disorder affec-ting multiple organ systems and is caused by infiltration of tissues by mature eosinophils. We describe the case of a patient in whom acute respiratory distress syndrome(ARDS) developed. The clinical course and the autopsy findings suggested HES as the cause.

 A 69-year-old man was hospitalized with high fever, systemic rash, cough, dyspnea, and eosinophilia. He had been prescribed some antibiotics in the clinic that he had consulted a few days previously. There was no definite history of his having taken these drugs previously.

 Results of routine laboratory chemical, microbiological, hematological, and viral studies were within normal limits.

 His general condition didn't improve after discontinuance of these drugs, so treatment with intravenous methylprednisolone was started. Immediatly after this, signs and symptoms were diminished, but nasal congestion continued.

 However, the symptoms recurred one month later, and he was readmitted to hospital. A chest computed tomography scan revealed a focal interstitial pattern, which subsequently extended rapidly to the whole pulmonary area. Bronchoscopy showed mucoid impaction and all-pervading redness of the bronchi. A diagnosis on ARDS was made at this point, but the patient's general condition worsened daily and, in spite of assisted ventilation, he died of respiratory failure.

 Autopsy revealed infiltration of parenchymatous organ tissues by mature eosinophils, but there was no tumorous proliferation of myelocytes in the bone marrow. Lung tissue showed diffuse alveolar damage(DAD), which supported the clinical diagnosis of ARDS. Inflammatory cytokines and/or other chemical mediators released from eosinophils were suspected to be the cause.

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