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Title: Wanneer een idiopathisch hypereosinofiel syndroom niet idiopathisch is
Author(s): DE CLERCK F, DE WILDE V, ORLENT H, LODEWYCK T, VANDECASTEELE S
Journal: Tijdschrift voor Geneeskunde
Volume: 71    Issue: 8   Date: 2015   
Pages: 548-551
DOI: 10.2143/TVG.71.08.2001847

Abstract :
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When an idiopathic hypereosinophilic syndrome is not idiopathic
A 67-year-old male patient presented with abdominal pain, anorexia, recurrent urticaria and weight loss since eight months accompanied by eosinophilia. During his professional career, he had travelled across Asia, Africa, Oceania and the Americas. He did not receive any new medication during the past year. A thorough search for invasive parasites revealed a positive serology for Toxocara, but a treatment with mebendazol did not result in a clinical improvement. The abdominal imaging was normal. An upper endoscopy revealed duodenitis with prominent eosinophilic infiltration. A bone marrow examination did not indicate underlying haematological proliferative diseases and the diagnosis of an idiopathic hypereosinophilic syndrome was made. A treatment with steroids resulted in a marked symptomatic improvement, with a rapid recurrence when the dose was decreased. Imatinib was added to the treatment, but did not result in a
significant improvement. A few weeks later, the patient presented with an Enterococcus faecalis meningitis. A repeat endoscopy revealed the presence of Strongyloides stercoralis in the duodenal biopsies. The diagnosis of a Strongyloides stercoralis infection complicated with an iatrogenic hyperinfection syndrome was made and the patient recovered completely after a treatment with ivermectin and cessation of the steroids.


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