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SOUTHEASTASIANJ TROPMEDPUBLICHEALTH

1322 Vol 41 No. 6 November 2010

Correspondence: Dr Keng-Yin Loh, Interna-tional Medical University Malaysia, JalanRasah, Seremban 70300, Malaysia.Tel: (06) 012 237 3328E-mail: manjusri_loh@yahoo.com

cc. kengyin_loh@imu.edu.my

CASE REPORT

HYPEREOSINOPHILIA RESPONDING TO EMPIRICAL

ANTIHELMINTHIC TREATMENT

Keng-Yin Loh and Xin-Er Lee

International Medical University Malaysia, Seremban, Malaysia

Abstract. We report a 20-year-old college student presents with bilateral ankleedema associated with hypereosinophilia following a history of traveling in a ru-ral area. Physical examinations and investigations failed to diagnose any underly-ing cause. She was treated with antihelminth medication and the edema subsided

within a week and the eosinophil counts normalized within two weeks.

Key works: hypereosinophilia, edema, antihelminthic treatment

INTRODUCTION

An eosinophil count of 1-3% is nor-mal for adult (Rothenberg, 1998).Eosino-phil can be caused by parasitic infectionssuch as ascariasis, filariasis, and allergics,such as asthma and eczema (Weller and

Bubley, 1994; Ackerman and Butterfield,2000). Eosinophilia has also been associ-ated with malignancies, such as lym-phoma and myloproliferative disordersand autoimmune connective tissue disor-ders (Clauw and Crofford, 1994).

The major step in managing a patientwith eosinophilia is to ascertain the under-lying cause and to treat accordingly. How-ever if underlying causes failed to be diag-

nosed, empirical therapy with antihelminthfor patients presenting with eosinophiliamay be helpful especially if they are froman endemic area for parasitic helminth in-festation. This clinical case illustrated a pa-

tient with hypereosinophilia respondedwell to antihelminth treatment empirically.

CASE REPORT

A 25- year-old college student fromMalaysia, presented with a 2 week history

of lethargy and pedal edema (Fig1). Shedenied any significant past medical his-tory. The only significant history was 6weeks prior to presentation she went on atrip to Cambodia, but denied any fever,injury or known infection. The physicalexamination revealed only pedal edema.The complete blood count (Fig 2) showeda hemoglobin of 13.7g%, a total white

blood cell count of 14.2 x 106/l, with 25%

neutrophils, 19% lymphocytes, 4%mono-cytes, 1% basophils and 51% eosinophils.He platelet count was 236x106/l. Her urineanalysis, renal function and liver functiontests were normal. Stool microscopy wasnegative for ova and parasites. A magneticresonance image (MRI) of her chest, ab-domen and pelvis was negative. A connec-tive tissue disease screen was also nega-tive. Bone marrow aspiration was not per-

formed due to patient refusal.

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Vol 41 No. 6 November 2010 1323

to rule out leukemia.

Since the investigations in this patientwere normal and no specific cause wasidentified, she was started antihelminthicempirical treatment. This approach was ap-

propriate in view of a recent travel historyand the fact that parasitic infections remaina major cause of hypereosinophilia world-wide (Weller and Bubley, 1994; Rothenberg,1998; Ackerman and Butterfield, 2000).

REFERENCES

Ackerman SJ, Butterfield JH. Eosinophilia,eosinophil-associated diseases, and the

hypereosinophilic syndrome. In: Hoffman

R, Benz EJ Jr, Shattil SJ, eds. Hematology:basic principles and practice. 3rded. New

York: Churchill Livingstone, 2000: 702-20.

Clauw DJ, Crofford LJ. Eosinophilic rheumaticdisorders. Rheum Dis Clin North Am 1995;21: 231-46.

Rothenberg ME. Eosinophilia. N Engl J Med

1998; 338: 1592-600.

Weller PF, Bubley GJ. The idiopathichypereosinophilic syndrome. Blood1994;

83: 2759-79.

Fig 2Peripheral blood film of patient show-

ing the typical bilobed nucleus of eosi-nophils and cytoplasmic granules

stained pink with Wright-Giemsa stain(x1,000).

Fig 1Pedal edema of patient.

In view of the hypereosinophilia withno clinical or laboratory evidence of he-matological malignancy, she was treatedempirically with albendazole 400 mg dailyfor 3 consecutive days. Her limb edemasubsided on Day 3 of treatment and a re-peat differential counts showed a markedreduction in eosinophil count to 35%. Oneweek later it was 10% and two weeks laterit was 3%. She is currently asymptomatic.

DISCUSSION

The management of eosinophilia in-cludes determining the cause and treatingit accordingly. Necessary investigationsinclude stool examinations to detect intes-tinal helminthes, connective tissue screen-ing and to screening for cardiac, hepaticand renal involvement. Bone marrow as-

piration and biopsy should be considered