A 56-year-old female with idiopathic hypereosinophilic syndrome who presented with chest tightness, dyspnea and new-onset atrial fibrillation is reported. Work up revealed significant peripheral eosinophilia, pericarditis, and a pericardial effusion with tamponade physiology. Pericardiocentesis revealed predominant eosinophils (88%) in the pericardial fluid. After initial stabilization, pericardial effusion reaccumulated with persistence of marked eosinophilia. A diagnosis of idiopathic hypereosinophilic syndrome was made, and she was started on prednisone with a dramatic resolution of her clinical symptoms.
Key Points
* Any organ may be involved in idiopathic hypereosinophilic syndrome (IHES) as a result of an infiltration of tissue by eosinophils.
* The syndrome is divided into three stages: the necrotic stage, the thrombotic stage, and the fibrotic stage.
* Pericardial involvement with IHES is extremely infrequent.
* It is very important to institute appropriate treatments in patients with IHES early on to achieve a good response.