Abstract
Hypereosinophilic syndrome (HES) is a hypereosinophilia (blood eosinophils › 1500/mm³) with organ damage and/or dysfunction due to eosinophil invasion. It can be caused by hematologic neoplasms (primary HES) or stimulated by parasitic infections, etc. (secondary HES). Sublingual immunotherapy (SLIT) is an established treatment option for pollenosis (hay fever). In addition to anaphylaxis, eosinophilic esophagitis (EE) has been reported as a complication of SLIT. However, this complication is not well known. We report the case of a 67- year-old woman with SLIT-induced HES who presented with fever and anasarca following laryngeal edema. She was clinically diagnosed with eosinophilic pericarditis and eosinophilic esophagitis. Although pathological evidence of eosinophilic esophagitis and pericarditis was lacking, we successfully treated the patient with 1 mg/kg of prednisolone after excluding primary HES. To the best of our knowledge, there have been no previous reports of eosinophilic pericarditis associated with SLIT, but we thought the patient had eosinophilic pericarditis because the pericardial effusion decreased after glucocorticoid administration. Given that generalists will be in charge of acute management of eosinophilic complications of SLIT, such as EE and anaphylaxis, our report will remind general physicians to be aware of the eosinophilic complications of SLIT.
