Idiopathic hypereosinophilic syndrome complicated by computed tomography-negative cerebral infarction, strangulated intestinal obstruction, and hepatic portal venous gas: a case report of multi-system involvement
Year: 2025
Type: article
Study design: Case Report
Abstract: Background: Idiopathic hypereosinophilic syndrome (HES) is a rare disorder characterized by persistent eosinophilia, which can lead to multi-organ dysfunction. Despite its highly heterogeneous clinical manifestations, cardiac and neurological complications are the most significant contributors to patient disability and mortality. Case Description: /L). Initial diagnostic evaluation, including head computed tomography (CT) combined with CT angiography and CT perfusion, showed no significant abnormalities. However, magnetic resonance imaging confirmed an acute infarct in the left basal ganglia-paraventricular area. To control hypereosinophilia, dexamethasone (10 mg/day) was initiated. Due to the patient's suboptimal therapeutic response, treatment was escalated to prednisolone (15 mg three times a day) for intensive management 2 days later. Following clinical stabilization, the regimen was transitioned back to dexamethasone for maintenance therapy (2.25 mg once daily at discharge), in accordance with standard steroid tapering protocols in HES. On the seventh day, the patient developed sudden signs of generalized peritonitis, and imaging revealed intestinal ischemia. By the tenth day, the classic triad of strangulated intestinal obstruction had emerged; that is, progressive abdominal pain, positive fecal occult blood (+++), and CT findings of a pneumoportogram with terminal ileal wall edema. Emergency exploratory laparotomy confirmed extensive intestinal necrosis, necessitating radical intestinal resection and jejunostomy. Following stepwise management, digestive tract reconstruction (jejunostomy reduction and end-to-side anastomosis of the small intestine and colon) was successfully performed. Current follow-up indicates a good prognosis. Conclusions: This case provides valuable clinical insights into the early identification and management of thrombotic critical conditions secondary to idiopathic HES. It also highlights multi-dimensional intervention strategies for short bowel syndrome, expanding post-intestinal resection management pathways.
Authors: Haoran Wei, Chenghao Ji, Fanhe Dong, Yuqiang Shan, Wencheng Kong
Language: English
Subfield: Rheumatology
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W4415655941
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