Distal deep vein thrombosis as a presenting manifestation of tropical hyper-eosinophilia

Authors

  • Vishnu Sharma Department of Medicine, SMS Medical College, Jaipur, Rajasthan, India
  • Vansh Bagrodia Department of Medicine, SMS Medical College, Jaipur, Rajasthan, India
  • Arpita Digwal Department of Medicine, SMS Medical College, Jaipur, Rajasthan, India
  • Tanishk Parchwani Department of Medicine, SMS Medical College, Jaipur, Rajasthan, India

DOI:

https://doi.org/10.18203/2320-6012.ijrms20243394

Keywords:

HE, DVT, Filariasis, Tropical eosinophilia, Rivaroxaban

Abstract

A young woman with swelling and pain in her left leg was diagnosed with deep vein thrombosis (DVT) confirmed by Doppler study. However, she also had hypereosinophilia (HE), which led to investigations for possible underlying causes. Positive serologic testing for Filariasis suggested it as the likely cause, highlighting DVT as a presenting manifestation of tropical HE. Treatment with rivaroxaban for DVT and antiparasitic medication led to normalization of eosinophil counts and complete resolution of DVT on follow-up. This case presents a rare occurrence of DVT seen as a presentation with tropical HE.

References

Antonucci R, Vacca N, Boz G, Cristian L, Rosanna M, Claudio C, et al. Parasitic Hypereosinophilia in Childhood: a Diagnostic Challenge. Mediterr J Hematol Infect Dis. 2018;10(1):e2018034.

Bain B, Pierre R, Imbert M, Vardiman JW, Vardiman JW, Brunning RD, Fladrin G. Chronic eosinophilic leukaemia and the hypereosinophilicsyndrome. World Health Organization classification of tumours: pathology and genetics of tumours of hematopoietic and lymphoid tissue. Lyon: IARC Press. 2001;29-31.

Ogbogu PU, Bochner BS, Butterfield JH, Gleich GJ, Huss-Marp J, Kahn JE, et al. Hypereosinophilic syndromes: a multicenter, retrospective analysis of clinical characteristics and response to therapy. J Allergy Clin Immunol. 2009;124(6):1319-25.

Crous-Bou M, Harrington LB, Kabrhel C. Environmental and genetic risk factors associated with venous thromboembolism. Semin Thromb Hemost. 2016;42(8):808-20.

Schellong S, Ageno W, Casella IB, Kok HC, Sam S, Daniel ES, et al. Profile of Patients with Isolated Distal Deep Vein Thrombosis versus Proximal Deep Vein Thrombosis or Pulmonary Embolism: re-covery DVT/PE Study. Semin Thromb Hemost. 2022;48(4):446-58.

WHO: Global programme to eliminate Lymphatic Filariasis: progress report, 2013, WER No 38, 2014;89:409-18.

Chandy A, Alok ST, Mukesh PS, Ashish M. A review of neglected tropical diseases: filariasis. Asian Pacific J Trop Med. 2011;4(7):581-6.

Uderhardt S, Jochen AA, Tobias F, Victoria JH, Johann W, Peter S, et al. Enzymatic lipid oxidation by eosinophils propagates coagulation, hemostasis, and thrombotic disease. J Exp Med. 2017;214(7):2121-38.

Wang JG, Shawn AM, Jacob AT, Jian-Guo G, Nigel SK, Arne S, et al. The principal eosinophil peroxidase product, HOSCN, is a uniquely potent phagocyte oxidant inducer of endothelial cell tissue factor activity: a potential mechanism for thrombosis in eosinophilic inflammatory states. Blood. 2006;107(2):558-65.

Moosbauer C, Eberhard M, Susan LC, Davit M, Kiril B, Sybille A, et al. Eosinophils are a major intravascular location for tissue factor storage and exposure. Blood. 2007;109(3):995-1002.

Spry CJ, Davies J, Tai PC, Olsen EG, Oakley CM, Goodwin JF. Clinical features of fifteen patients with the hypereosinophilic syndrome. Q J Med. 1983;52(205):1-22.

Wassom DL, Loegering DA, Solley GO, Moore SB, Schooley RT, Fauci AS, et al. Elevated serum levels of the eosinophil granule major basic protein in patients with eosinophilia. J Clin Invest. 1981;67(3):651-61.

Liapis H, Ho AK, Brown D, Mindel G, Gleich G. Thrombotic microangiopathy associated with the hypereosinophilic syndrome. Kidney Int. 2005;67:1806-11.

Su WQ, Yan-Zhong F, Shu-Yan L, Meng-Jie C, Ya-Bin X, Fei-Fei S, Wen-Chao L. Eosinophilia complicated with venous thromboembolism: A case report. World J Clin Cases. 2022;10(6):1952-60.

Ogbogu PU, Rosing DRM, McDonald K. Horne MDCardiovascular Manifestations of Hypereosinophilic Syndromes, Immunology and Allergy Clinics of North Am. 2007;27(3):457-75.

Di Micco P, Scudiero O, Lombardo B, Lodigiani C. Idiopathic Hypereosinophilia and Venous Thromboembolism: Is There a Pathophysiological or Clinical Link? Description of an Intriguing Clinical Case. J Blood Med. 2020;11:73-6.

Gao SJ, Wei W, Chen JT, Tan YH, Yu CB, Litzow MR, Liu QJ. Hypereosinophilic syndrome presenting with multiple organ infiltration and deep venous thrombosis: A case report and literature review. Medicine (Baltimore). 2016;95(35):e4658.

Hayashida M, Yano A, Hagiwara K, Nagamoto S, Ogawa K, Sakaguchi K, et al. A Case Report: Eosinophilic Cystitis Presented with Deep Vein Thrombosis. Nihon Hinyokika Gakkai Zasshi. 2019;110(4):266-9.

Khatib R, Ross S, Kennedy SA, Florez ID, Ortel TL, Nieuwlaat R, et al. Home vs hospital treatment of low-risk venous thromboembolism: a systematic review and meta-analysis. Blood Adv. 2020;4(3):500-13.

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Published

2024-10-30

How to Cite

Sharma, V., Bagrodia, V., Digwal, A., & Parchwani, T. (2024). Distal deep vein thrombosis as a presenting manifestation of tropical hyper-eosinophilia. International Journal of Research in Medical Sciences, 12(11), 4319–4322. https://doi.org/10.18203/2320-6012.ijrms20243394

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Section

Case Reports