A 71-Year-Old Woman with Eosinophilia Manifesting with Progressive Digital Ischemia: A Case Report

Penumarty RD*, Varikara K and Valeriparambath K

Division of Medicine, Lyell McEwin Hospital, Northern Adelaide Health Network, Australia

^*Correspondance to: Rama Penumarty 

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Abstract:

Eosinophilic disorders can cause endothelial injury and microvascular thrombosis, but destructive digital ischemia is rare. We present here a 71-year-old woman with asthma, diabetes mellitus, and chronic kidney disease who presented with diarrhoeal illness, dehydration and acute kidney injury followed by progressive oedema and painful unilateral digital cyanosis that advanced to necrosis despite vasodilator therapy. Laboratory testing revealed marked eosinophilia (2.79–4.87 × 10⁹/L), elevated IgE (1880 IU/mL), hypocomplementemia, and weakly positive antineutrophil cytoplasmic antibodies. Arterial imaging showed no large-vessel occlusion, and positron-emission tomography excluded malignancy. Skin biopsy demonstrated patchy inflammation without necrotizing vasculitis and weak granular C3 deposition. High-dose glucocorticoids produced rapid normalization of eosinophil counts and inflammatory markers, although digital necrosis required surgical terminalization. The findings were most consistent with a steroid-responsive hypereosinophilic small-vessel vasculopathy within the spectrum of eosinophilic vascular syndrome than ANCA-negative eosinophilic granulomatosis with polyangiitis. Early recognition is essential to prevent irreversible ischemic injury.

Keywords:

Hypereosinophilic syndrome; Digital ischemia; Eosinophilia; EGPA; Vasculopathy

Cite the Article:

Penumarty RD, Varikara K, Valeriparambath K. A 71-Year-Old Woman with Eosinophilia Manifesting with Progressive Digital Ischemia: A Case Report. Ann Clin Case Rep. 2026; 11: 2831..