Abstract Ref Number = APCP1228
HYPEREOSINOPHILIA IN ADOLESCENT WITH THROMBOANGITIS OBLITERANS A CASE REPORT
Dea Sella Sabrina,Iqbal Fahmi, Fhiserra Kusuma Primadhani,Sri Mulatsih,Sutaryo ,Haryo Aribowo
Department of Child Health Faculty of Medicine Public Health and Nursing Universitas Gadjah Mada Dr Sardjito General Hospital Yogyakarta Indonesia Department of Child Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada Dr Sardjito General Hospital, Yogyakarta, Indonesia Department of Thoracic and Cardiovascular Surgery, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada Dr Sardjito General Hospital, Yogyakarta, Indonesia
Background : Hypereosinophilia is defined as a peripheral blood eosinophil count greater than 1,500/mm3. Common causes of hypereosinophilia are infections, allergic responses, neoplasms, connective tissue disorders, medications, and endocrinopathies. This case report describes hypereosinophilia with thromboangitis obliterans in a 16-year-old boy.
Case Presentation Summary : A 16-year-old boy came with painful finger gangrenes. The complaint began with pain, warm, itchy right thumb and index finger since one month before admission. Complaints were getting worse until all fingers were gangrene. The pain scale was 8/10. Patient was alcoholic and had smoking history since six months before the symptoms began. There was no history of allergy in family. Physical examination showed necrotic fingers and undetected pulsation and saturation of right radial and ulnar arteries of the right hand. Thoracic and abdominal examination were normal and no lymphadenopathy was found. Laboratory examination showed white blood cell counts of 73,620 cells/mm3 (bands 18%, segments 6%, eosinophils 72%, lymphocytes 4%) and absolute eosinophilic counts (AEC) were 53,006 cells/mm3. CRP was 68 mg/L, procalcitonin was 4.61 ng/mL, IgE was >1000 IU/L, and rheumatoid factor was positive. Bone marrow biopsy revealed hypereosinophilia (83%). Fecal examination was normal. The patient was treated with heparin 400 IU/h, fentanyl 20 mcg/h, and underwent amputation of all fingers of the right hand. After amputation, the eosinophil counts returned to normal.
Learning Points/Discussion : Hypereosinophilia in thromboangitis obliterans is very rare. The cause of hypereosinophilia is still unknown. This case probably was caused by alcoholism and smoking which induced an allergic reaction that could be the mechanism for vascular injury. Long term follow-up and laboratory examination are required to determine the cause, treatment, and preventive measures.
Keywords: Hypereosinophilia thromboangitis obliterans adolescent