Hypereosinophilic Syndrome, Churg-Strauss Syndrome and Parasitic Diseases: Possible Links between Eosinophilia and Thrombosis
Alberto Maino, Raffaella Rossio, Massimo Cugno, Angelo V. Marzano and Alberto Tedeschi
Affiliation: Allergy and Clinical Immunology Unit, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Via Pace, 9 - 20122 Milan, Italy.
Keywords: Eosinophil, hypereosinophilic syndrome, Churg-Strauss syndrome, parasitic infestations, thrombosis, platelet activating factor, myocardial infarction, stroke, vasculitis, heparin
Throughout the past decade, a possible role of eosinophils in blood coagulation and thrombosis has been suggested.
We conducted a Pubmed (MEDLINE) search of case and series referring to any kind of thrombotic events described
in three conditions characterised by persistent blood eosinophilia, i.e. the hypereosinophilic syndrome (HES), the
Churg Strauss syndrome (CSS), and parasitic infestations from 1966 to date. One hundred and ninety-two articles were
found regarding thrombotic events in HES and CSS, and 209 cases of thrombosis were extracted. One hundred and seventy-
seven articles dealing with parasitic diseases and thrombosis were found, but only 15 manuscripts reporting thrombosis
of unknown origin in 22 patients were selected. In HES, arterial thromboses were more frequent than in CSS
(p=0.006), representing almost half of the cases (45%), while venous and mixed artero-venous thrombosis were respectively
28% and 27%. In contrast, in CSS there was a predominance of venous thrombosis (56%, p=0.006), with arterial
thrombosis representing 38% of total thrombotic events, and mixed thrombosis being the least frequent (4%). The higher
incidence of arterial thrombosis in HES patients can be explained by the common cardiac involvement (64% of patients).
In the 22 patients with parasitoses and thrombosis, 15 had arterial thrombosis (68%) and 7 had venous thrombosis (32 %).
Literature analysis shows that there are numerous reports of thrombotic events in patients with eosinophil-related disorders
supporting a role for eosinophils in thrombosis. This observation raises the problem of prevention and treatment of
thromboembolism particularly in HES and CSS patients.
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