Hypereosinophilic syndrome with severe hypokalaemia in a Nigerian woman: A case report

Abstract

Introduction: Hypereosinophilic syndrome (HES) is a rare disorder.It is defined as eosinophilia of greater than1.5x10⁹ /L persisting for at least 6 months or death before 6 months without an identifiable cause and with eosinophil-mediated organ dysfunction.We present a rare case of hypereosinophilic syndrome with severe hypokalaemia in a Nigerian female patient.

Case presentation: A 43year old food vendor referred to the Haematology Department, University College Hospital, Ibadan on account of a 6-week history of cough productive of mucoid, brownish, foul smelling sputum with associated breathlessness, high grade intermittent fever,and intense pruritus. She had accompanying non-projectile,non-bloody vomiting of recently ingested meals.

There was absolute eosinophilia of 83x10⁹/L and bone marrow cytology revealed marked eosinophilia with blasts of less than 5%. She also had asymptomatic severe hypokalaemia (1.9mmol/l) likely due to vomiting and reduced dietary intake.The aetiology of the hypereosinophilia could not be ascertained.She was admitted and commenced on intranasal oxygen,Tabs Loratidine, intravenous hydration.The severe hypokalaemia was corrected with IV KCL over 48hours followed with the administration of slow K tablets 600mg tds. She also had tabs Hydroxyurea for cytoreduction and Allopurinol to prevent hyperuricaemia.She improved with the above line of management.

Conclusion: This appears to be the first reported case of HES with asymptomatic severe hypokalaemia in the literature. Being a rare disorder it could easily have been missed without a review of the peripheral blood film and marrow aspirate. This finding suggests a possible relationship between hypereosinophilia and hypokalemia which needs to be explored.

Keywords: Hypereosinophilic syndrome, Eosinophilia, Bone marrow cytology, Hypokalemia, Hydroxyurea, Loratidine