Hypereosinophilic Syndrom Of Different Pathogeny With Pulmonary Embolism:3 Case Reports And Literature Review

OBJECTIVE: To Improve the understanding of hypereosinophilic syndrome (HES) of different pathogeny with pulmonary embolism.METHODS: We undertaken a retrospective analysis on the 3 cases of hypereosinophilic syndrome of different causes accompanying with pulmonary embolism admitted to the first affiliated hospital of Guangxi medical university from October 2014 to October 2015, and reviewed relatived literatures."Eosinophil, Pulmonary embolism" as the Chinese key words, "Eosinophilic,Hypereosinophilic, Pulmonary embolism/thrombosis" as the English key words,to search the literatures from China National Knowledge Infrastructure(CNKI)databases, Wanfang databases and PubMed.RESULTS: The three patients were young or middle-aged males. The clinical manifestations included cough, hemoptysis, chest pain, rash, joint pain,fever, and dyspnea, which was the most dominant manifestation. Two cases had increased white blood cells. The eosinophilic ratio (0.17?0.43 ) and absolute value(1.82?7.38)×109 of three cases were dominantly high. Two patients had obviously deceased blood platelets. ESR and CRP levels in three cases could be elevated. The ratios of eosinophils in their bone marrow, skin, lung tissue,pleural effusion were remarkably high. Finally they were definitely diagnosed with reactive HES due to parasite infection, secondary HES by collagen disease,and idiopathic HES. CTPA demonstrated. pulmonary embolisms, and consolidation and pleural effusions as well. Patients receiving simplicity treatment of thrombolysis or anticoagulation improved little. After, they did not improved well until their primary diseases were treated with glucocorticoids or immunosuppressant. After searching databases, we found 25 articles,from January 1970 to May 2017, reporting 25 cases, 10 Chinese articles, 15 in English, including 19 male, 6 female, age ranged from 9 to 65, the average was 40. Averaged white blood cell count was (5.3?28.32 )×109/L with averaged eosinophils ( 2.19?20.09)×109/L. Most of them had thrombocytopenia(12/15cases). ESR?CRP?IgE were high. 7 cases were diagnosed as Idiopathic HES, 8 secondary/reactive, 3 neoplastic, 7 with unclear classifications . The variety of clinical menifestations due to the difference of organ damage/dysfunction caused by HES, including other arteriovenous thrombosis(20cases),lung and pleural involvement (13 cases). After anticoagulation and dealing with the primany causes of HES, some of them adding with glucocorticoid or immunosuppressive, conditions of 19 patients were improved, and 2 patients died.CONCLUSIONS: (1) HES patients in any age ranges can suffer from pulmonary embolism, no matter what causing their HES. (2) The common clinical features concluded the elevated eosinophilic in peripheral blood and elevated Inflammatory markers, thrombocytopenia, arterial-venous thrombosis,eosinophils infiltration in bone marrow, lungs and pleural. (3) The patients can have favorable prognosis after treated by glucocorticoid reducing the eosinophils as well as anticoagulation, and simultaneously removing pathogeny of the HES.