Hypereosinophilia and Neuroophthalmological manifestations in Lymphoma

Objective: NA Background: While hypereosinophilia is commonly associated with allergies and parasitic and fungal infections, it is an uncommon manifestation of hematological malignancies. Here is a case of idiopathic hypereosinophilia in a patient who presented with neurologic signs but remarkably found to have no imaging abnormalities initially. Design/Methods: 66-year-old gentleman presented with year-long symptoms of pruritus, failure to thrive, weight loss, dry cough and double vision. Physical examination revealed some notable ophthalmic findings, including right eye junctional scotoma with patchy but reduced visual field bilaterally and esotropia in all directions with minimal limitation of abduction and adduction in each eye (right greater than left). His laboratory workup showed increased absolute eosinophil count (7670 cells/mm 3 ) with morphologically abnormal eosinophils and eosinophilic precursors on bone marrow biopsy. Unremarkable cytogenetic studies were reported. Initial brain imaging was negative but later manifested leptomeningeal enhancement and bilateral occipital lobe changes with normal orbital MRI; Positron emission tomography also showed uptake in jejunal loops and mesenteric lymph nodes. Lumbar puncture findings were minimally abnormal. The patient eventually succumbed and a postmortem examination revealed and confirmed the diagnosis of peripheral T-cell lymphoma, not otherwise specified (PTCL, NOS; CD3+, CD4−) with diffuse serosits and visceral infiltration. Results: Inflammatory and neoplastic pathology is very hideous and occasionally challenging to confirm without tissue diagnosis. My patient had extensive negative work up leaving the official diagnosis elusive until confirmation on autopsy. His hypereosinophilia was thought to be related to paraneoplastic phenomena that is secondary to cytokine expression by the malignant cells. PTCL, NOS constitutes 25% of PTCL in adults and 4% of non-hodgkin lymphoma overall. Bone marrow is only involved in 22% cases. Conclusions: Hypereosinophilia is a paraneoplastic marker of lymphomas and can be seen in 29% of cases with PTCL but it’s a nonspecific finding making diagnosis challenging. Disclosure: Dr. Khalid has nothing to disclose. Dr. May has nothing to disclose. Dr. Chow has nothing to disclose. Dr. Bond has nothing to disclose.