Hypereosinophilic syndrome

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Maria Fernanda Villarreal, M.D. [2] Synonyms and keywords: Synonym 1; Synonym 2; Synonym 3

Overview

Hypereosinophilic syndrome (HES) is a disease characterized by a persistently elevated eosinophil count (≥ 1500 eosinophils/mm³) in the blood for at least six months without any recognizable cause, with involvement of either the heart, nervous system, or bone marrow. Hypereosinophilic syndrome is a diagnosis of exclusion, after clonal eosinophilia (such as leukemia) and reactive eosinophilia (in response to infection, autoimmune disease, atopy, hypoadrenalism, tropical eosinophilia, or cancer) have been ruled out. There are some associations with chronic eosinophilic leukemia as it shows similar characteristics and genetic defects. If left untreated, hypereosinophilic syndrome is progressively fatal. It is treated with glucocorticoids such as prednisone. The addition of the monoclonal antibody mepolizumab may reduce the dose of glucocorticoids.

Historical Perspective

• Hypereosinophilic syndrome was first described in 1968.
• In 2003, PDGFRA and FIP1L1 genes mutations were first identified in the pathogenesis of hypereosinophilic syndrome.

Classification

• Hypereosinophilic syndrome may be classified into 2 groups:

• Endomyocardial fibrosis

• Also known as Davies disease

• Loeffler's endocarditis

• Other variants of hypereosinophilic syndrome may include DRESS syndrome.

Pathophysiology

• The pathogenesis of hypereosinophilic syndrome is characterized by [feature1], [feature2], and [feature3].
• The [gene name] gene/Mutation in [gene name] has been associated with the development of hypereosinophilic syndrome, involving the [molecular pathway] pathway.
• On gross pathology, [feature1], [feature2], and [feature3] are characteristic findings of hypereosinophilic syndrome.
• On microscopic histopathological analysis, [feature1], [feature2], and [feature3] are characteristic findings of hypereosinophilic syndrome.

Causes

• Hypereosinophilic syndrome may be caused by either [cause1], [cause2], or [cause3].
• Hypereosinophilic syndrome is caused by a mutation in the [gene1], [gene2], or [gene3] gene[s].
• There are no established causes for hypereosinophilic syndrome.

Differentiating hypereosinophilic syndrome from other Diseases

• Hypereosinophilic syndrome must be differentiated from other diseases that cause [clinical feature 1], [clinical feature 2], and [clinical feature 3], such as:

• [Differential dx1]
• [Differential dx2]
• [Differential dx3]

Epidemiology and Demographics

• The prevalence of hypereosinophilic syndrome is approximately [number or range] per 100,000 individuals worldwide.
• In [year], the incidence of hypereosinophilic syndrome was estimated to be [number or range] cases per 100,000 individuals in [location].

Age

• Patients of all age groups may develop hypereosinophilic syndrome.

• Hypereosinophilic syndrome is more commonly observed among patients aged [age range] years old.
• Hypereosinophilic syndrome is more commonly observed among [elderly patients/young patients/children].

Gender

• Hypereosinophilic syndrome affects men and women equally.

• [Gender 1] are more commonly affected with hypereosinophilic syndrome than [gender 2].
• The [gender 1] to [Gender 2] ratio is approximately [number > 1] to 1.

Race

• There is no racial predilection for hypereosinophilic syndrome.

• Hypereosinophilic syndrome usually affects individuals of the [race 1] race.
• [Race 2] individuals are less likely to develop hypereosinophilic syndrome.

Risk Factors

• Common risk factors in the development of hypereosinophilic syndrome are [risk factor 1], [risk factor 2], [risk factor 3], and [risk factor 4].

Natural History, Complications and Prognosis

• The majority of patients with hypereosinophilic syndrome remain asymptomatic for [duration/years].
• Early clinical features include [manifestation 1], [manifestation 2], and [manifestation 3].
• If left untreated, [#%] of patients with hypereosinophilic syndrome may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].
• Common complications of hypereosinophilic syndrome include [complication 1], [complication 2], and [complication 3].
• Prognosis is generally [excellent/good/poor], and the [1/5/10­year mortality/survival rate] of patients with hypereosinophilic syndrome is approximately [#%]

Diagnosis

Diagnostic Criteria

• The diagnosis of hypereosinophilic syndrome is made when at least 2 of the following 5 diagnostic criteria are met:

• Persistently elevated eosinophil count (≥ 1500 eosinophils/mm³) in the blood
• [criterion 2]
• [criterion 3]
• [criterion 4]

Symptoms

• [Disease name] is usually asymptomatic.
• Symptoms of [disease name] may include the following:

• [symptom 1]
• [symptom 2]
• [symptom 3]
• [symptom 4]
• [symptom 5]
• [symptom 6]

Physical Examination

• Patients with [disease name] usually appear [general appearance].
• Physical examination may be remarkable for:

• [finding 1]
• [finding 2]
• [finding 3]
• [finding 4]
• [finding 5]
• [finding 6]

Laboratory Findings

• There are no specific laboratory findings associated with [disease name].

• A [positive/negative] [test name] is diagnostic of [disease name].
• An [elevated/reduced] concentration of [serum/blood/urinary/CSF/other] [lab test] is diagnostic of [disease name].
• Other laboratory findings consistent with the diagnosis of [disease name] include [abnormal test 1], [abnormal test 2], and [abnormal test 3].

Imaging Findings

• There are no [imaging study] findings associated with [disease name].

• [Imaging study 1] is the imaging modality of choice for [disease name].
• On [imaging study 1], [disease name] is characterized by [finding 1], [finding 2], and [finding 3].
• [Imaging study 2] may demonstrate [finding 1], [finding 2], and [finding 3].

Other Diagnostic Studies

• [Disease name] may also be diagnosed using [diagnostic study name].
• Findings on [diagnostic study name] include [finding 1], [finding 2], and [finding 3].

Treatment

Medical Therapy

• There is no treatment for [disease name]; the mainstay of therapy is supportive care.

• The mainstay of therapy for [disease name] is [medical therapy 1] and [medical therapy 2].
• [Medical therapy 1] acts by [mechanism of action1].
• Response to [medical therapy 1] can be monitored with [test/physical finding/imaging] every [frequency/duration].

Surgery

• Surgery is the mainstay of therapy for [disease name].
• [Surgical procedure] in conjunction with [chemotherapy/radiation] is the most common approach to the treatment of [disease name].
• [Surgical procedure] can only be performed for patients with [disease stage] [disease name].

Prevention

• There are no primary preventive measures available for [disease name].

• Effective measures for the primary prevention of [disease name] include [measure1], [measure2], and [measure3].

• Once diagnosed and successfully treated, patients with [disease name] are followed-up every [duration]. Follow-up testing includes [test 1], [test 2], and [test 3].