Disseminated Eosinophilic Collagen Disease

A patient with disseminated eosinophilic collagen disease as reported in the Scandanavian and European literature and perhaps described under various titles—such as eosinophilic leukemia, Loeffler’s syndrome, parietal endocarditis,¹⁶ and allergic granulomatosis¹⁷—is presented. The major clinical findings are dermal edema and erythema with pruritus and scaling; skeletal muscle pain, tenderness, and weakness; severe arthralgias and stiffness of small and weightbearing joints; hepatomegaly; and conspicuous lack of adenopathy. Blood examination shows normochromic anemia with intense neutrophilic leukocytosis and eosinophilia. Granulocytic leukemoid features eventually appear resembling chronic to subacute myelogenous or eosinophilic leukemia. Cardiac failure or infection is the usual cause of death. At autopsy there is generalized eosinophilic and neutrophilic with lesser mononuclear infiltrations of many organs, particularly the skin, myocardium, and skeletal muscle. The etiology is unknown. Environmental toxicities and hyperimmunity perhaps to drugs, bacterial products, or sustained autoantigenic stimuli are suggested possible explanations. Corticosteroids afford some symptomatic stabilization but the disease pursues a persistent downhill course.