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The Hypereosinophilia Dilemma: What’s Beyond Cardiac Involvement?

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Sep 17, 2025

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Figure 1

Strain echocardiography performed in 2025 revealed moderate left ventricular systolic dysfunction (EF: 42.5%; GLS: −8%), with more pronounced impairment in the inferior wall.
Strain echocardiography performed in 2025 revealed moderate left ventricular systolic dysfunction (EF: 42.5%; GLS: −8%), with more pronounced impairment in the inferior wall.

Timeline of diagnostic feature evolution

Feature 2023 2024 2025
Asthma + +
Eosinophilia + + +
ENT involvement
Pulmonary infiltrates +
Neuropathy (mononeuritis multiplex) + + +
Skin manifestations
Cardiac involvement + + +
Gastrointestinal involvement
Renal involvement
ANCA positivity
Histopathology
Systemic symptoms + + +

Temporal evolution of the important laboratory parameters (2)

Data Proteinuria (mg/24h) C3 (g/L) C4 (g/L) C-ANCA AB (UI/ml) P-ANCA AB (UI/ml)
January–February 2023 126 1.01 0.11
January 2024 80.4 01.08 0.2 2.36 1.73
June–July 2025 103.51 1.52 0.07 0.45 0.28

Antibody levels relevant to vasculitis workup

Antibodies Value Reference range for normal
Anti-dsDNA (IU/mL) 13.52 <200
Anti-CCP (IU/mL) 1.40 0–20
Anti-Ro (Anti-SSA) (IU/mL) 0.78 0–20
Anti-Sm (Anti-SSB) (IU/mL) 1.93 0–20
Antinuclear AB(ANA) (IU/mL) 9.04 0–20
Anti-β2 Glycoprotein I IgG (SGU/mL) 2.47 0–20
Anti-cardiolipin IgG (GLP/mL) 1.36 0–20
Anti-cardiolipin IgM(MPL/mL) 5.73 0–20

Serum protein electrophoresis in 2025

Serum protein electrophoresis Normal range
Beta B1 6.20 4.70 – 7.20 %
Beta B2 6.90 3.20 – 6.50 %
Alfa 2 13.40 7.10 – 11.80 %
Alfa 1 6.10 2.90 – 4.90 %
Albumin 49.00 55.80 – 66.10 %
Albumin-Globulin ratio 0.96 1.1–2.5
Gamma 18.40 10.5–19.2 %

Temporal evolution of the important laboratory parameters (1)

Data Eosinophiles (*1000/mcL) CRP (mg/L) ESR (mm/h) Fibrinogen (mg/dl) IgE (IU/ml) NTproBNP (pg/mL) hsTnT (pg/mL) LDH (UI/L)
January 2023 15.36 38.5 32 482 1296 6174 1445 607
February 2023 0.06 0.27 2 226 1967 50.24
July 2023 0.24 0.99 4 762 18.96
January 2024 1.64 0.7 2 349 219 539 10.02 206
April 2024 1.24 1.05 7 371 275 500
June 2025 7.00 42.5 55 539 3782 509 15 502
July 2025 0.03 1.63 7 336 966 366 232
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