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Scientific Letter
Eosinophilic Pleural Effusion as a Manifestation of Idiopathic Hypereosinophilic Syndrome
Derrame pleural eosinofílico secundario a síndrome hipereosinofílico idiopático
Jorge Lima Álvareza,
Corresponding author
, Nicolás Peña Griñána, Isabel Simón Pilob
a Unidad de Neumología, Hospital Universitario Virgen de Valme, Sevilla, Spain
b Unidad de Hematología, Hospital Universitario Virgen de Valme, Sevilla, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Eosinophilic pleural effusion &#40;EPE&#41; is pleural effusion &#40;PE&#41; in which eosinophils account for more than 10&#37; of pleural fluid &#40;PF&#41; cellularity&#46; In published series on PE&#44; about 7&#46;5&#37; of the population show EPE&#46;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1&#44;2</span></a> The most common overall cause of EPE is air or blood in the pleural space and the most common known etiology is malignant disease&#46; Idiopathic hypereosinophilic syndrome &#40;IHES&#41; is a heterogeneous group of disorders consisting of hypereosinophilia&#44; defined as an absolute eosinophil count &#62;1&#46;5&#215;10<span class="elsevierStyleSup">9</span>&#47;l or &#62;1500<span class="elsevierStyleHsp" style=""></span>cells&#47;&#956;l in 2 consecutive samples obtained 1 month apart&#44; combined with eosinophil-induced organ damage&#44; when other causes of hypereosinophilia have been excluded&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">We report the case of a 25-year-old man with bilateral PE &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; Complete blood count showed eosinophil concentrations of 3500&#47;mm<span class="elsevierStyleSup">3</span>&#44; representing 26&#37; of total white blood cells&#46; He had shown similar results on previous tests&#46; PF initially had a turbid appearance&#44; with characteristics of exudate&#44; glucose levels of 64<span class="elsevierStyleHsp" style=""></span>mg&#47;dl and adenosine deaminase levels of 27&#46;7<span class="elsevierStyleHsp" style=""></span>U&#47;l&#46; PF cytology showed no malignant cells and acutely predominant inflammatory cells&#44; with abundant eosinophils &#40;50&#37;&#8211;60&#37; of total cell count&#41;&#46; PF culture was negative for bacteria&#44; mycobacteria and fungi&#46; Echocardiography showed neither pericardial effusion nor infiltrative cardiomyopathy&#46; Tests were performed to rule out secondary causes of hypereosinophilia&#44; all of which were negative&#44; and after comprehensive hematological studies&#44; the diagnosis was IHES&#46; Response to prednisone 1<span class="elsevierStyleHsp" style=""></span>mg&#47;kg was favorable&#46; The eosinophilia abated initially in peripheral blood and subsequently&#44; after 7 months&#44; in PE&#46; Eosinophil levels in normal PF are low &#40;less than 1&#37;&#41;&#46; High levels can be due to multiple causes&#46; The most common causes of EPE are malignant &#40;around 30&#37;&#8211;34&#37;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1&#44;2</span></a>&#41;&#44; parapneumonic&#44; and tuberculous effusion&#46; Other possible etiologies include asbestos&#44; drug toxicities&#44; parasitical infections&#44; and Churg-Strauss syndrome&#44; or less commonly&#44; viral infections and pulmonary embolism&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> Very little information is available on EPE due to IHES or causes other than those mentioned&#44; as can be surmised from the few cases reported to date&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> The particular interest in this patient is that the disease started only as relapsing EPE&#46; In one of the published cases&#44; the patient had hepatosplenomegaly and ascites combined with bilateral PE&#44; and unlike our patient&#44; the outcome was death&#46; In addition to bilateral EPE&#44; the other patient presented skin lesions which were found to be due to vasculitis&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a></p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">When EPE with no apparent etiology is observed&#44; IHES must be considered&#46; Eosinophilia in peripheral blood in the absence of other manifestations should alert to the presence of this entity&#46; Close collaboration with the hematologist is necessary to confirm the etiology of this finding&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Lima &#193;lvarez J&#44; Pe&#241;a Gri&#241;&#225;n N&#44; Sim&#243;n Pilo I&#46; Derrame pleural eosinof&#237;lico secundario a s&#237;ndrome hipereosinof&#237;lico idiop&#225;tico&#46; Arch Bronconeumol&#46; 2016&#59;52&#58;538&#46;</p>"
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ISSN: 15792129
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