A Case of Idiopathic Hypereosinophilic Syndrome with Oral and Cervical Edema

Abstract

The patient was a 66-year-old female who had been aware of dyspnea due to swelling in the perimandibular region for more than a month. Findings from an initial facial examination revealed diffuse swelling in the submental region with no fever or pain. The mucosa of the oral floor presented as a double tongue due to edema, and the patient was aware of respiratory distress. Ortho-panoramic radiography, cervical echocardiography, and a CT scan were negative for neoplastic lesions. Blood tests showed an eosinophil count of 1,380/ul and so an allergic reaction was suspected. Since anti-allergic drugs were not effective and there was no improvement in the clinical symptoms, we recommended the patient see an internal medicine physician. At the internal medicine department, the patient was diagnosed with idiopathic hypereosinophilic syndrome due to an eosinophil count of 2,157/ul and a bone marrow examination that was negative for leukemia. Steroid therapy quickly reduced the eosinophil count. Prolonged hypereosinophilia may cause organ damage. The present case suggests that it is necessary to keep in mind a differential diagnosis of oral and cervical swelling.