Extensive digital gangrene without evidence of large-vessel occlusion in hypereosinophilic syndrome.

Hypereosinophilic syndrome (HES) comprises a group of rare disorders characterized by persistence of blood hypereosinophilia (>1500 mm ') for >6 months; and definite signs of organ involvement without the secondary causes of eosinophilia ( 1 ). Cutaneous findings are present in up to 50% of patients with HES, e.g. pruritic papules, eczema-like patches, urticarial plaques, and angioedema ( 1). In HES patients, occlusions of intermediateto largesized arteries frequently cause peripheral ischaemia and even digital gangrene (2-6). Digital necrosis without evidence for vascular occlusion has rarely been described in patients with HES (7). We report here a case of HES complicated by severe digital gangrene without angiographie evidence of occlusion of peripheral arteries, but with histopathological evidence of occlusion of cutaneous small vessels by micro-thrombi.