The clinical investigator

, Volume 72, Issue 12, pp 1060–1064 | Cite as

Two cases of neurologigal manifestations in eosinophilia: variations of one disease?

  • S. Ostrowitzkil
  • S. Zierz
Case Reports

Abstract

The hypereosinophilic syndrome is characterized by a long-lasting increase in circulating eosinophils in the absence of a definable etiology and by manifestations of multisystem involvement. It must be differentiated from the eosinophiliamyalgia syndrome related to the ingestion of L-tryptophan, although the clinical features may be similar. Two patients with hypereosinophilia not related to L-tryptophan intake are described who both became clinically symptomatic with neurological manifestations of acute and subacute onset: one with eosinophilic fasciitis and the other with painful polyneuropathy. Both responded well to corticosteroids.

Key words

Hypereosinophilic syndrome Eosinophilic fasciitis Polyneuropathy Eosinophiliamyalgia syndrome 

Abbreviations

CT

computed tomography

HES

hypereosinophilic syndrome

EMS

eosinophilic-myalgia syndrome

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References

  1. 1.
    Agrawal BL, Giesen PC (1981) Eosinophilic myositis. An unusual cause of pseudotumor and eosinophilia. JAMA 246:70–71Google Scholar
  2. 2.
    Avgerinos PC, Papadimitriou CS, Kokkini G, Moutsopoulos HM (1982) Asymptomatic diffuse fasciitis with eosinophilia. Ann Rheumatic Diseases 41:621–622Google Scholar
  3. 3.
    Botet MV, Sánchez JL (1980) The fascia in systemic scleroderma. J Am Acad Dermatol 3:36–42Google Scholar
  4. 4.
    Burns SM, Lange DJ, Jaffe I, Hays AP (1994) Axonal neuropathy in eosinophilia-maylgia syndrome. Muscle Nerve 17:293–298Google Scholar
  5. 5.
    Churg J, Strauss L (1951) Allergic granulomatosis, allergic angiitis and periarteritis nodosa. Am J Pathol 27:277–301Google Scholar
  6. 6.
    Chusid MJ, Dale DC, West BC, Wolff SM (1975) The hypereosinophilic syndrome: analysis of fourteen cases with review of the literature. Medicine 54:1–27Google Scholar
  7. 7.
    Don IJ, Khettry U, Canoso JJ (1978) Progressive systemic sclerosis with eosinophilia and a fulminating course. Am J Med 65:346–348Google Scholar
  8. 8.
    Donofrio PD, Stanton C, van Miller S, Oestreich L, Lefkowitz DS, Walker FO, Ely EW (1992) Demyelinating polyneuropathy in eosinophilia-myalgia syndrome. Muscle Nerve 15:796–805Google Scholar
  9. 9.
    Dorfman LJ, Ransom BR, Forno LS, Kelts A (1983) Neuropathy in the hypereosinophilic syndrome. Muscle Nerve 6:291–298Google Scholar
  10. 10.
    Durack DT, Sumi SM, Klebanoff S (1979) Neurotoxicity of human eosinophils. Proc Natl Acad Sci 76:1443–1447Google Scholar
  11. 11.
    Fauci AS, Harley JB, Roberts WC, Ferrans VJ, Gralnick HR, Bjornson BH (1982) The idiopathic hypereosinophilic syndrome. Clinical, pathophysiologic and therapeutic considerations. Ann Intern Med 97:78–92Google Scholar
  12. 12.
    Fleischmajer R, Jacotot AB, Shore S, Binnick SA (1978) Scleroderma, eosinophilia, and diffuse fasciitis. Arch Dermatol 114:1320–1325Google Scholar
  13. 13.
    Freundlich B, Werth VP, Rook AH, O'Connor CR, Schumacher HR, Leyden JJ, Stolley PD (1990) L-Tryptophan ingestion associated with cosinophilic fasciitis but not progressive systemic sclerosis. Ann Intern Med 112:758–762Google Scholar
  14. 14.
    Jaffe I, Kopelman R, Baird R, Grossman M, Hays A (1990) Eosinophilic fasciitis associated with the eosinophilia-myalgia syndrome. Am J Med 88:542–546Google Scholar
  15. 15.
    Lakhanpal S, Duffy J, Engel AG (1988) Eosinophilia associated with perimyositis and pneumonitis. Mayo Clin Proc 63:37–41Google Scholar
  16. 16.
    Lanham JG, Elkon KB, Pusey CD, Hughes GR (1984) Systemic vasculitis with asthma and eosinophilia: a clinical approach to the Churg-Strauss syndrome. Medicine 63:65–81Google Scholar
  17. 17.
    Lewkonia RM, Marx LH, Atkinson MH (1982) Granulomatous vasculitis in the syndrome of diffuse fasciitis with eosinophilia. Arch Intern Med 142:73–75Google Scholar
  18. 18.
    Lupo I, Raimondo D, Rodolico V, Camarda RM (1989) Peripheral neuropathy in the hypereosinophilic syndrome. A case report. Eur Neurol 29:269–272Google Scholar
  19. 19.
    Marazzi R, Pareyson D, Boiardi A, Corbo M, Scaioli V, Sghirlanzoni A (1992) Peripheral nerve involvement in Churg-Strauss syndrome. J Neurol 239:317–321Google Scholar
  20. 20.
    Medsger TA (1990) Tryptophan-induced eosinophilia-myalgia syndrome. N Engl J Med 322:926Google Scholar
  21. 21.
    Michet CJ, Doyle JA, Ginsburg WW (1981) Eosinophilic fasciitis. Report of 15 cases. Mayo Clin Proc 56:27–34Google Scholar
  22. 22.
    Monaco S, Lucci B, Laperchia N, Tezzon F, Currò-Dossi B, Nardelli E, Giannini C, Rizzuto N (1988) Polyneuropathy in hypereosinophilic syndrome. Neurology 38:494–496Google Scholar
  23. 23.
    Moore PM, Harley JB, Fauci AS (1985) Neurologic dysfunction in the idiopathic hypereosinophilic syndrome. Ann Intern Med 102:109–114Google Scholar
  24. 24.
    Moutsopoulos HM, Webber BL, Pavlidis NA, Fostiropoulos G, Goules D, Shulman LE (1980) Diffuse fasciitis with eosinophilia: a clinicopathologic study. Am J Med 68:701–708Google Scholar
  25. 25.
    Nir MA, Westfried M (1981) Hypereosinophilic dermatitis. A distinct manifestation of the hypereosinophilic syndrome with response to dapsone. Dermatologica 162:444–450Google Scholar
  26. 26.
    Oppolzer G, Duschet P, Schwarz T, Hutterer J, Gschnait F (1988) Die hypereosinophile Dermatitis (Nir-Westfried). Eine Variante des Hypereosinophiliesyndroms. Z Hautkrank 63:123–125Google Scholar
  27. 27.
    Parillo JE, Fauci AS, Wolff SM (1978) Therapy of the hypereosinophilic syndrome. Ann Intern Med 89:167–172Google Scholar
  28. 28.
    Prick JJW, Gabreels-Festen AAWM, Korten JJ, van der Wiel TWM (1988) Neurological manifestations of the hypereosinophilic syndrome (HES). Clin Neurol Neurosurg 90:269–273Google Scholar
  29. 29.
    Rodnan GP, Lipinski E, Rabin BS, Reichlin M (1977) Eosinophilia and serologic abnormalities in linear localized scleroderma. Arthritis Rheum 20:133Google Scholar
  30. 30.
    Satsangi J, Donaghy M (1992) Multifocal peripheral neuropathy in eosinophilic fasciitis. J Neurol 239:91–92Google Scholar
  31. 31.
    Shulman LE (1974) Diffuse fasciitis with hypergammaglobulinemia and eosinophilia: a new syndrome? J Rheumatol [Supp] 1]:46Google Scholar
  32. 32.
    Shulman LE (1975) Diffuse fasciitis with eosinophilia: a new syndrome? Trans Assoc Am Physicians 88:70–86Google Scholar
  33. 33.
    Shulman LE (1976) Diffuse fasciitis with eosinophilia: a new syndrome. Arthritis Rheum [Supp] 19]: 205–217Google Scholar
  34. 34.
    Silver RM, Heyes MP, Maize JC, Quearry B, Vionnet-Fuasset M, Sternberg EM (1990) Scleroderma, fasciitis, and eosinophilia associated with the ingestion of tryptophan. N Engl J Med 322:874–881Google Scholar
  35. 35.
    Sladek MD, Vasey FB, Sieger B, Behnke DA, Germain BF, Espinoza LR (1983) Relapsing eosinophilic myositis. J Rheumatol 10:467–470Google Scholar
  36. 36.
    Smit AJ, van Essen LH, de Vries EGE (1991) Successful long-term control of idiopathic hypereosinophilic syndrome with etoposide. Cancer 67:2826–2827Google Scholar
  37. 37.
    Spry CJF (1982) The hypereosinophilic syndrome: clinical features, laboratory findings and treatment. Allergy 37:539–551Google Scholar
  38. 38.
    Spry CJF, Davies J, Tai PC (1983) Clinical features of 15 patients with the hypereosinophilic syndrome. Q J Med New Series LII 205:1–22Google Scholar
  39. 39.
    Stark RJ (1979) Eosinophilic polymyositis. Arch Neurol 36:721–722Google Scholar
  40. 40.
    Stark E, Böhm M (1984) Polyneuropathie vom Landry-Verlaufstyp bei allergischer Granulomatose und Angiitis (Churg-Strauss Syndrom). Akt Neurol 11:44–46Google Scholar
  41. 41.
    Tai PC, Spry CJF, Olsen EGJ, Ackerman SJ, Dunnette S, Gleich GJ (1987) Deposits of eosinophil granule proteins in cardiac tissues of patients with eosinophilic endomyocardial disease. Lancet II:643–647Google Scholar
  42. 42.
    Tolander LM, Bamford CR (1991) Central and peripheral nervous system involvement in the L-tryptophan associated eosinophilia-myalgia syndrome. Int J Neurosci 61:69–75Google Scholar
  43. 43.
    Weaver DF, Heffernan LP, Purdy RA, Ing VW (1988) Eosinophil-induced neurotoxicity: axonal neuropathy, cerebral infarction, and dementia. Neurology 38:144–146Google Scholar
  44. 44.
    Wichman A, Buchthal F, Pezeshkpour GH, Fauci AS (1985) Peripheral neuropathy in hypereosinophilic syndrome. Neurology 35:1140–1145Google Scholar
  45. 45.
    Yonker RA, Panush RS (1985) Idiopathic eosinophilic myositis with preexisting fibromyalgia. J Rheumatol 12:165–167Google Scholar

Copyright information

© Springer-Verlag 1994

Authors and Affiliations

  • S. Ostrowitzkil
    • 1
  • S. Zierz
    • 2
  1. 1.Neurologische Universitätsklinik BonnBonnGermany
  2. 2.Neurologische Universitätsklinik Halle-WittenbergHalle/ScaleGermany

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