PITFALLS IN THE DIAGNOSIS OF HYPEREOSINOPHILIC SYNDROME - A REPORT OF2 CASES

The idiopathic hypereosinophilic syndrome is empirically defined as th e presence of prolonged eosinophilia without identifiable underlying c ause, and with evidence of end-organ dysfunction. Virtually any organ system may be involved, most frequently the heart, the central and per ipheral nervous system, the lungs and the skin. We report two cases wh ere the diagnosis of hypereosinophilic syndrome was proposed although the classic criteria were not met. In the first case total peripheral eosinophil counts were relatively low, but pathological evidence clear ly showed infiltration of eosinophils in the damaged tissues. An hypot hesis to explain this discrepancy is formulated. The second case did n ot fulfil the first feature either, although the clinical presentation and disease course corresponded well with other cases reported in the literature. The delay in diagnosis was caused by early institution of corticosteroids, clearing all evidence of eosinophil involvement in t he observed tissue damage.