217-218 Letter to the Editor 3.QXD

A 73-years old man was admitted on March 1997, complaining of asthenia, muscle weakness, dry cough, bronchospasm and paresthesis of arms and legs. A WBC count was 13.5 x 109/I with 44% of mature eosinophils. A blood test performed 7 months earlier revealed similar values. The neurological diagnosis was an axonal peripheral polyneuropathy (motor and sensitive). Stool examinations, IgE dosage, CAT scan of the brain and the thorax, echocardiogram and blood chemical values demonstrated no abnormalities. However, the CAT scan of the abdomen revealed hepatic tumors. A neoplasm of the liver with secondary blood eosinophilia was considered, and the tumor masses aspirated through a fine needle guided by CAT scan. The analysis of the aspirated material revealed infiltration by mature eosinophils. The diagnosis was IHS with hepatic tumoral lesions (HTL), and hydroxyurea (2 g per day) was started on April 1997. Six months later, the WBC count was 4.5 x 109/I with 5% of eosinophils. The patient had a pronounced clinical improvement, with weight gain (more than 10% over the previous weight), disappearance of the bronchospasm and recovery of neurological symptoms. A CAT scan of the abdomen, performed on June 1999, revealed reduction of the tumoral lesions (Figure 1). The patient is still receiving hydroxyurea, has normal eosinophils at WBC and remains with a Karnofsky score of 100%.