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Logo of bmcurolBioMed Centralsearchsubmit a manuscriptregisterthis articleBMC Urology
 
BMC Urol. 2012; 12: 7.
Published online Mar 21, 2012. doi:  10.1186/1471-2490-12-7
PMCID: PMC3348004
Severe paraneoplastic hypereosinophilia in metastatic renal cell carcinoma
Tilman Todenhöfer,1 Stefan Wirths,2 Claus Hann von Weyhern,3 Stefan Heckl,4 Marius Horger,5 Joerg Hennenlotter,1 Arnulf Stenzl,1 Lothar Kanz,2 and Christian Schwentnercorresponding author1,6
1Department of Urology, University Hospital Tuebingen, Tuebingen, Germany
2Department of Internal Medicine, Oncology, Hematology, University Hospital Tuebingen, Tuebingen, Germany
3Department of Pathology, University Hospital Tuebingen, Tuebingen, Germany
4Department of Neuroradiology, University Hospital Tuebingen, Tuebingen, Germany
5Department of Radiology, University Hospital Tuebingen, Tuebingen, Germany
6Department of Urology, Eberhard-Karls University, Hoppe-Seyler Strasse 3, D-72076 Tübingen, Germany
corresponding authorCorresponding author.
Tilman Todenhöfer: tilman.todenhoefer/at/med.uni-tuebingen.de; Stefan Wirths: stefan.wirths/at/med.uni-tuebingen.de; Claus Hann von Weyhern: c.vonweyhern/at/med.uni-tuebingen.de; Stefan Heckl: stefan.heckl/at/med.uni-tuebingen.de; Marius Horger: marius.horger/at/med.uni-tuebingen.de; Joerg Hennenlotter: joerg.hennenlotter/at/med.uni-tuebingen.de; Arnulf Stenzl: arnulf.stenzl/at/med.uni-tuebingen.de; Lothar Kanz: lothar.kanz/at/med.uni-tuebingen.de; Christian Schwentner: christian.schwentner/at/med.uni-tuebingen.de
Received November 7, 2011; Accepted March 21, 2012.
Abstract
Background
Renal cell carcinoma can cause various paraneoplastic syndromes including metabolic and hematologic disturbances. Paraneoplastic hypereosinophilia has been reported in a variety of hematologic and solid tumors. We present the first case in the literature of severe paraneoplastic hypereosinophilia in a patient with renal cell carcinoma.
Case presentation
A 46 year-old patient patient with a history of significant weight loss, reduced general state of health and coughing underwent radical nephrectomy for metastasized renal cell carcinoma. Three weeks after surgery, the patient presented with excessive peripheral hypereosinophilia leading to profound neurological symptoms due to cerebral microinfarction. Systemic treatment with prednisolone, hydroxyurea, vincristine, cytarabine, temsirolimus and sunitinib led to reduction of peripheral eosinophils but could not prevent rapid disease progression of the patient. At time of severe leukocytosis, a considerable increase of cytokines associated with hypereosinophilia was measurable.
Conclusions
Paraneoplastic hypereosinophilia in patients with renal cell carcinoma might indicate poor prognosis and rapid disease progression. Myelosuppressive therapy is required in symptomatic patients.
Keywords: Paraneoplastic, Hypereosinophilia, Leukocytosis, Renal cell carcinoma, Leukemoid reaction, Encephalopathy
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