A patient showing relapse of intradialytic hypotension caused by hypereosinophilia

A 66-year-old woman has been undergoing dialysis due to end-stage renal failure caused by diabetic nephropathy for the past 27 years. One and half years ago, she was hospitalized for the treatment of a skin rash all over her body with hypereosinophilia. At that time, her blood pressure dropped significantly after the initiation of dialysis and she developed a fever. Her dialyzer and dialysate were changed, but her condition did not improve. Topical application of betamethasone valerate and betamethasone propionate decreased her eosinophils and improved her skin rash, fever, and severe intradialytic hypotension. However, approximately one year after discontinuing the topical medication, severe intradialytic hypotension with a marked increase of eosinophilia reappeared without a skin rash or fever, and she was readmitted to the hospital in November 2023. A moderate dose of steroids suppressed hypereosinophilia and improved intradialytic hypotension markedly. Although rare, severe intradialytic hypotension occurs in dialysis patients with hypereosinophilia. There are a few reports of improvement with moderate-dose steroid therapy, but a recommended dosage has not been established. Based on the present findings, it is considered that a lower dose of steroids may improve severe intradialytic hypotension in dialysis patients with hypereosinophilia.