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Zum Spektrum des Hypereosinophiliesyndroms anhand zweier klinischer Fallbeispiele

Two clinical cases concerning the spectrum of hypereosinophilic syndrome

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An Erratum to this article was published on 01 August 1998

Zusammenfassung

□ Hintergrund

Anhand zweier schwerer Fälle von Hypereosinophiliesyndrom mit kardiopulmonaler Beteiligung, Erythema nodosum, eosinophiler Ileokolitis und Parästhesien werden Definition, mögliche Ursachen, Verlaufsformen, Organkomplikationen, pathophysiologische Mechanismen und Behandlungsmöglichkeiten dieses relativ seltenen Krankheitsbildes besprochen. Die Unterscheidung zwischen einer Eosinophilie und dem Hypereosinophiliesyndrom erfolgt aufgrund klarer Definition.

□ Differentialdiagnose

Die beiden beschriebenen Fälle von Hypereosinophiliesyndrom verdeutlichen die Schwierigkeit der Zuordnung zur reaktiven oder idiopathischen Verlaufsform dieses Syndroms. Bei zu früher Festlegung im Sinne einer reaktiven Form könnte eine zu günstige Prognose gestellt werden, während im Falle einer vermuteten idiopathischen Verlaufsform die wichtige Suche nach beeinflussenden Faktoren, wie zum beispiel Allergenen, unterbleiben könnte. Die hier vorgestellten Fälle verliefen aber im Beobachtungszeitraum mit hoher Wahrscheinlichkeit in jeweils eine der beiden Richtungen.

□ Schlußfolgerung

Es ist wichtig, gründlich nach verursachenden oder beeinflussenden Faktoren des Hypereosinophiliesyndroms, wie zum Beispiel nach Medikamenten oder Allergenen, zu suchen, um diese zu eliminieren. Das Hypereosinophiliesyndrom ist ferner engmaschig zu überwachen, um Komplikationen rechtzeitig zu erkennen und sie therapeutischen Maßnahmen zuzuführen.

Abstract

□ Background

Two severe cases of hypereosinophilic syndrome with cardiopulmonary symptoms, erythema nodosum, eosinophilic ileocolitis and paresthesia are reported. Definition, etiology, pathophysiological mechanisms, types, complications and therapeutic approaches of this relatively rare clinical disorder are discussed on the basis of these two cases. The distinction between eosinophilia and hypereosinophilic syndrome is clearly defined.

□ Differential Diagnosis

The 2 cases of hypereosinophilic syndrome demonstrate the difficulty to decide whether they represent the idiopathic or the reactive type of hypereosinophilic syndrome. If the assumption is made in favor of the reactive type of hypereosinophilic syndrome the assumed prognosis could eventually be too promising. In case of an assumed idiopathic type of hypereosinophilic syndrome the search for causing factors like allergens could be left out. The decision concerning the type of hypereosinophilic syndrome of the 2 case reported was made with high probability. In the case of idiopathic hypereosinophilic syndrome, eosinophilic leukemia was excluded by bone marrow biopsy.

□ Conclusion

In order to be able to make a diagnosis it is necessary to search carefully for causing and influencing factors of the hypereosinophilic syndrome such as, allergens or medicaments and to eliminate them. The hypereosinophilic syndrome must be put underfrequent control in order to avoid complications or to start with therapeutic approaches in time.

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Authors and Affiliations

  1. Medizinische Abteilung, Kreiskrankenhaus Pinneberg, Kliniken des Kreises Pinneberg, Fahltskamp 74, D-25421, Pinneberg, Deutschland

    Hartmut Nolte

  2. Institut für Pathologie, Universitätskrankenhaus Hamburg-Eppendorf, Hamburg-Eppendorf, Deutschland

    Udo Helmchen

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  1. Hartmut Nolte
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Ein Erratum zu diesem Beitrag ist unter http://dx.doi.org/10.1007/BF03042600 zu finden.

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Nolte, H., Helmchen, U. Zum Spektrum des Hypereosinophiliesyndroms anhand zweier klinischer Fallbeispiele. Med Klin 93, 426–432 (1998). https://doi.org/10.1007/BF03042639

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