Idiopathic hypereosinophilic syndrome (HES) is rare disease. Clinical features of idiopathic HES varies, such as dermatologic, pulmonary, gastrointestinal, cardiac, neurologic symptoms. Common symptoms are abdominal pain, nausea, vomiting and ascites. Other symptoms have few been reported. A 30-year-old woman visited our hospital with 6-months history of dyspnea. We diagnosed asthma by methacholine bronchial provocation test with typical history of asthma . 5 months ago, in an attempt to investigate the pathophysiology of her 2 years of otalgia, biopsy was done at right middle ear.
Methods: Complete Blood Cell Count, Biopsy of middle ear, MBPT
Initial laboratory tests were as follows: white blood cell count, 10,630 μ/L. Her differential count included 46% eosinophils. Total IgE count was 1,706 and eosinophil count was 3,900. We could not find any abnormal finding on abdomen & pelvis computed tomography. Methacholine bronchial provocation test, the lung function dropped 26% at 25mg/ml concentration. Biopsy was done at right middle ear which revealed inflamed granulation tissue with mucinous material and numerous eosinophils so she was diagonosed as eosinophilic otitis media.
She has asthma and eosinophilic otitis media. There was eosinophilia without definite cause. We thought she had been on systemic allergic condition, and we could not be ruled out idiopathic hypereosinophilic syndrome. The patient has been treated with 1mg/kg/day systemic methylprednisolone for one week which was successful. As idiopathic HES presenting as otalgia and dyspnea in adults has not been previously reported in the literature, we thought this could guide diagnosis in future cases.