Journal List > J Rheum Dis > v.24(3) > 1064324

Park, Lee, Park, and Yoo: Hypereosinophilic Syndrome Associated with the Onset of Rheumatoid Arthritis: A Case Report


Idiopathic hypereosinophilic syndrome (HES) is a disorder characterized by the sustained overproduction of eosinophils and multiple organ damage. Rheumatologic manifestations of HES are infrequent, but persistent eosinophilia is observed in approximately 10% to 40% of patients with rheumatoid arthritis (RA). This finding may be a result of the RA itself and is often associated with active disease and the presence of extraarticular features. We describe the case of a 48-year-old man affected by HES who subsequently developed RA. Both HES and RA responded rapidly to the corticosteroid and methotrexate therapy. In this patient, the initiation of RA and HES was related, suggesting a common pathogenetic link between these two diseases.


1. Weller PF, Bubley GJ. The idiopathic hypereosinophilic syndrome. Blood. 1994; 83:2759–79.
2. Chaudhuri K, Dubey S, Zaphiropoulos G. Idiopathic hypereosinophilic syndrome in a patient with longstanding rheumatoid arthritis: a case report. Rheumatology (Oxford). 2002; 41:349–50.
3. Winchester RJ, Koffler D, Litwin SD, Kunkel HG. Observations on the eosinophilia of certain patients with rheumatoid arthritis. Arthritis Rheum. 1971; 14:650–65.
4. Aletaha D, Neogi T, Silman AJ, Funovits J, Felson DT, Bingham CO 3rd, et al. 2010 Rheumatoid arthritis classification criteria: an American College of Rheumatology/ European League Against Rheumatism collaborative initiative. Arthritis Rheum. 2010; 62:2569–81.
5. Roufosse FE, Goldman M, Cogan E. Hypereosinophilic syndromes. Orphanet J Rare Dis. 2007; 2:37.
6. Bain BJ. Eosinophilia–idiopathic or not? N Engl J Med. 1999; 341:1141–3.
7. Seifert M, Gerth J, Gajda M, Pester F, Pfeifer R, Wolf G. Eosinophilia–a challenging differential diagnosis. Med Klin (Munich). 2008; 103:591–7.
8. Brogadir SP, Goldwein MI, Schumacher HR. A hypereosinophilic syndrome mimicking rheumatoid arthritis. Am J Med. 1980; 69:799–802.
9. Prattichizzo FA, Bernini L. An idiopathic hypereosinophilic syndrome mimicking seronegative rheumatoid arthritis: 20-year follow-up with clinical and laboratory findings. Clin Exp Rheumatol. 1992; 10:79–81.
10. Martín-Santos JM, Mulero J, Andréu JL, de Villa LF, Bernaldo-de Quirós L, et al. Arthritis in idiopathic hypereosinophilic syndrome. Arthritis Rheum. 1988; 31:120–5.
11. Tay C. Eosinophilic arthritis. Rheumatology (Oxford). 1999; 38:1188–94.
12. Bonanno D, Fedele R, Minciullo P, Quattrocchi P, Ferlazzo B. Idiopathic hypereosinophilic syndrome associated with rheumatoid arthritis. A case report. Reumatismo. 2003; 55:181–3.
13. Rosenstein RK, Panush RS, Kramer N, Rosenstein ED. Hypereosinophilia and seroconversion of rheumatoid arthritis. Clin Rheumatol. 2014; 33:1685–8.
14. Boomars KA, van Velzen-Blad H, Mulder PG, Koenderman L, Lammers JW, van den Bosch JM. Eosinophil cationic protein and immunoglobulin levels in bronchoalveolar lavage fluid obtained from patients with chronic eosinophilic pneumonia. Eur Respir J. 1996; 9:2488–93.

Figure 1.
High-resolution computed tomography scan of the lungs reveals subpleural distribution of small hyperdense nodules (black arrow) in the right lower lobe.
Figure 2.
Bone scan shows hot spots in both ankles and wrists, a sign of arthritis. Delayed regional bone images show increased radiotracer uptake in both ankles, both feet, and both wrists.
Similar articles