In his history, the patient did not present comorbidities and no history of any medication consumption.
Multiple skin lesions with central hypopigmentation and perilesional hyperpigmentation. Photo: Case Report.
Eosinophilia occurs when the level of eosinophils is higher than normal and they are a type of disease-fighting white blood cell. Although this condition is commonly seen in rheumatologic patients, it can be seen in other diseases such as eosinophilic granulomatosis with polyangiitis (EGPA) and, less frequently, in dermatomyositis, severe rheumatoid arthritis, progressive systemic sclerosis, and rarely Sjogren’s syndrome. It has been described in patients with systemic lupus erythematosus, according to the literature.
However, the scientific literature recently reported a case of a 17-year-old male who presented with multiple leg injuries over 7 months.
According to the report, they began as painless, fluid-filled lesions that later drained pus and resolved spontaneously. Likewise, before the hospitalization of this patient, the report indicates that he went through between 10 to 14 episodes of feces with mucus that were not associated with fever, abdominal pain and vomiting.
Dry gangrene on the second toe of the left foot. Photo: Case Report.
Subsequently, the male developed acute pain and dry gangrene at the tip of the second toe of the left foot involving the middle of the phalanx. He also complained of swelling of lower extremities and facial. she also had a productive cough with hemoptysis no chest pain or shortness of breath. She also complained of fatigue, anorexia and presented significant weight loss.
A lower lobe biopsy left revealed necrotic tissue. A complete blood count showed anemia and eosinophilia, and the patient also showed elevated inflammatory markers. Peripheral blood smear showed increase. The antinuclear antibody (ANA) was positive with a homogeneous pattern, however, its ANA immunoblot was negative.
A contrast-enhanced computed tomography (CECT) scan of the chest and pulmonary angiography revealed multiple cavitary wall lesions. intermediate in lower lobes bilateral.
He was started on high-dose oral prednisolone, mycophenolate mofetil, hydroxychloroquine, and anticoagulation. One week after initiation of immunosuppressive therapy, her blood count revealed a decrease in eosinophil count of 13%. Three months later, at follow-up, the patient was symptom-free, the report says.
The case points to an atypical presentation of SLE with eosinophilia. SLE should be maintained at diagnosis differential of persistent patients with unexplained eosinophilia. Being a rare entity, the diagnosis of this SLE with eosinophilia as its main point can be difficult, but once diagnosed, this condition responds to high doses of corticosteroids and immunomodulatory therapy, the authors concluded.
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