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Open Access Case report

Severe paraneoplastic hypereosinophilia in metastatic renal cell carcinoma

Tilman Todenhöfer1, Stefan Wirths2, Claus Hann von Weyhern3, Stefan Heckl4, Marius Horger5, Joerg Hennenlotter1, Arnulf Stenzl1, Lothar Kanz2 and Christian Schwentner16*

Author Affiliations

1 Department of Urology, University Hospital Tuebingen, Tuebingen, Germany

2 Department of Internal Medicine, Oncology, Hematology, University Hospital Tuebingen, Tuebingen, Germany

3 Department of Pathology, University Hospital Tuebingen, Tuebingen, Germany

4 Department of Neuroradiology, University Hospital Tuebingen, Tuebingen, Germany

5 Department of Radiology, University Hospital Tuebingen, Tuebingen, Germany

6 Department of Urology, Eberhard-Karls University, Hoppe-Seyler Strasse 3, D-72076 Tübingen, Germany

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BMC Urology 2012, 12:7  doi:10.1186/1471-2490-12-7

Published: 21 March 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