case_images: PMC10565030_01
case_images: Patient 1 cerebrovascular imaging studies, blood eosinophil counts, and HES treatment. (A) Cerebral CT-scan showing left middle cerebral artery irregularities with "flute-beak" appearance. (B,C) Diffusion-weighted cerebral magnetic resonance showing cortico-subcortical left hemispheric infarction, and intramural hypersignal on T1 sequences of the left middle cerebral artery suggesting presence of a vessel-wall hematoma. (D) Temporal evolution of AEC and therapy. AEC, absolute eosinophil count; HU, hydroxyurea; MPDN, methylprednisolone; peg-IFN-alpha, pegylated interferon-alpha; qd, every day; qw, every week; q2w/4w, every two/four weeks.
case_images: fcvm-10-1256862-g001.jpg
case_images: PMC10565030_01_fcvm-10-1256862-g001.jpg
case_images: F1
case_images: Cerebral computed tomography (CT)-scan showed a cortico-subcortical left hemispheric infarction, and magnetic resonance (MR)-angiography with vessel wall imaging sequences suggested dissection of the left middle cerebral artery (Figures 1A-C). The daily OCS dose was increased and AEC normalized within 24 h (Figure 1D).
case_images: PMC10565030_02
case_images: Patient 2 cardiovascular imaging and histology, blood eosinophil counts, and HES treatment. (A) Coronary angiography showing aneurysmal dilation of CA ( ) and extrinsic compression of the left main trunk by a VS aneurysm ( ). (B) Aortic MR-angiography showing giant polylobulated aneurysms occupying the non-coronary and the left VS. (C) Perioperative transesophageal echocardiography showing mural thrombus in a VS aneurysm. (D) Temporal evolution of AEC, Troponin Ths and therapy. (E) Immuno-fluorescent staining for eMBP-1 on resected aorta from patient 2 and from a control normo-eosinophilic subject with an aortic dissection, showing intact eosinophils (8 per high power field) and patchy extracellular granule protein deposition in patient 2's aortic adventitia. Prominent non-specific staining was observed in the media in both patient and control, with a similar pattern to control staining with rabbit immunoglobulin (not shown). 100X magnification. ACS, acute coronary syndrome; AEC, absolute eosinophil count; CA, coronary arteries; CT, computed tomography; eMBP-1, Eosinophil major basic protein; OCS, oral corticosteroid; VS, Valsalva sinus.
case_images: fcvm-10-1256862-g002.jpg
case_images: PMC10565030_02_fcvm-10-1256862-g002.jpg
case_images: F2
case_images: Coronary angiography showed proximal aneurysmal dilatation of all three coronary arteries (CA), with compression of the left main trunk by a Valsalva sinus (VS) aneurysm (Figures 2A-C). Hypereosinophilia was considered the likely cause of vascular injury and MPDN was initiated (Figure 2D). Eosinophil major basic protein (eMBP1) (Figure 2E) and eosinophil derived neurotoxin (EDN) (not shown) staining by indirect immunofluorescence showed intact eosinophils (6-8/high-power-field) and patchy extracellular deposits in the adventitia of the resected proximal aorta.