A 23-year-old Japanese man was referred to our hospital, complaining of a 1-month history of livedo reticularis, painful erythematous indurated patches, and Raynaud phenomenon on the hands and feet (Figure 1A). Although he was a cigarette smoker, he had no atopic diathesis or related disorders and no history of diabetes mellitus, hepatitis C, or drug exposure.
Laboratory investigations revealed a persistent eosinophilia (7191 white blood cells/μL; normal, <500 cells/μL) and elevated levels of eosinophilic cationic protein (101 μg/mL; normal, <14.7 μg/mL). Serum IgE level was 1103 μg/L (normal, <726 μg/L). The results of renal function tests, including urinalysis, creatinine and serum protein electrophoresis, and urine protein electrophoresis, were normal. Immunologic test results, including antinuclear antibody, antineutrophil cytoplasmic antibody, anticardiolipin antibodies, lupus anticoagulant, and rheumatoid factor, were all negative. Tests for cryoglobulins and cryofibrinogen showed negative results. Hepatitis C antibody was not detected. Repeated searches for parasites in the stool and parasite serologic indications were also negative.
Hamada T, Kimura Y, Hayashi S, Nakama T, Hashimoto T. Hypereosinophilic Syndrome With Peripheral Circulatory Insufficiency and Cutaneous Microthrombi. Arch Dermatol. 2007;143(6):799–816. doi:10.1001/archderm.143.6.812
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