A 26 year-old-male with nil significant past medical history presented to
us with swelling of left lower limb since 2 weeks. He has tachyapnea and
tachycardia. His JVP was normal and cardiac auscultation was normal.
Examination was suggestive of deep vein thrombosis (DVT) of the left
lower limb. Doppler of lower limb confirmed this and patient was appropriately
placed on anti-coagulation. He had persistently elevated blood eosinophil
counts. Bone marrow biopsy was and mutational analysis confirmed
presence of lymphocytic variant of hypereosinophilic syndrome (HES).
He continued to have tachycardia and cardiac enzymes were positive.
Electrocardiogram revealed sinus tachycardia and echo was normal.
After ruling out the possibility of pulmonary thromboembolism with CT
pulmonary angiogram, myocarditis was attributed to HES. He was promptly
treated glucocorticoids which were later tapered gradually in lieu of
improvement of his clinical condition and declining eosinophil counts. He
was discharged and was under regular follow-up.
Key words: Hypereosinophilic syndrome, Persistent eosinophilia, Deep vein thrombosis, Myocarditis