Other / General Medicine
Felix A. Zayas Rodriguez, MD
Resident Physician
University of Miami / Jackson Health System
Miami, Florida, United States
Nareka Trewick, MD
Resident Physician
University of Miami/Jackson Health System
Miami, Florida, United States
Julia C. Abchee, BS
Medical Student
University of Miami
Miami, Florida, United States
Nicole L. Pontee, MD, MS
Assistant Professor
University of Miami Miller School of Medicine/Jackson Health Systems
Miami, Florida, United States
Felix A. Zayas Rodriguez, MD
Resident Physician
University of Miami / Jackson Health System
Miami, Florida, United States
A 49-year-old male was admitted for diffuse myalgias and rhabdomyolysis, initially managed with intravenous fluids. Despite treatment, he continued to have persistent proximal pain and weakness, most pronounced in the legs. Further workup included a muscle biopsy, which revealed hypereosinophilia. A prior cardiac MRI had shown findings concerning for infiltrative cardiomyopathy, initially thought to represent amyloidosis. In the context of a persistently elevated absolute eosinophil count, Rheumatology considered multiorgan hypereosinophilic syndrome (HES).
The patient was treated with a prolonged prednisone taper, resulting in improved eosinophil counts and clinical symptoms. During inpatient rehabilitation, his proximal pain and weakness improved with continued steroids, allowing him to achieve meaningful functional gains.
Discussions:
Multiorgan hypereosinophilic syndrome is rare and presents with diverse clinical manifestations, including myopathy and cardiomyopathy. This case highlights the importance of considering less common etiologies when evaluating persistent myalgias and systemic findings. In this patient, the combination of muscle biopsy results, cardiac MRI abnormalities, and elevated eosinophil counts shed light on the possible diagnosis and guided appropriate therapy.
Equally important was interdisciplinary collaboration, as each discipline's input ensured accurate diagnosis, effective treatment, and safe progression through rehabilitation. Optimizing medical management allowed the patient to actively participate in therapy and maximize functional recovery.
Conclusions:
Identifying the underlying cause of persistent symptoms is critical to ensuring safe rehabilitation and functional improvement. In patients with systemic findings, considering rare conditions such as hypereosinophilic syndrome can be key to directing appropriate therapy. Close collaboration between physiatry and specialty teams facilitates comprehensive care and optimal rehabilitation outcomes.
