Hypereosinophilic syndrome: correlation between clinical severity and cutaneous microthrombi

A 32‐year‐old man, with a 12‐year history of recurrent edema of the upper and lower extremities, was admitted in February 1998 due to edema of the right forearm and tiredness of 1‐month duration. Examination revealed an ill‐defined, itchy, slightly erythematous, indurated patch with excoriation on the right forearm (Fig. 1). There was no history of drug intake, atopy, or asthma. He recalled, however, having experienced cold‐induced Raynaud's phenomenon and intermittent arthralgia. In laboratory tests, there was a white cell count of 11.77 × 103/μL with 48% eosinophils (4830/μL). Liver function tests showed elevated serum glutamic pyruvic transaminase (SGPT) and alkaline phosphatase. Rheumatoid factor was positive. Total immunoglobulin E (IgE) concentration was elevated to 4703 U/mL (normal,