SARS-COV-2 INFECTION ASSOCIATED WITH NEW SEVERE HYPEREOSINOPHILIA AND MULTIPLE ORGAN DAMAGE

INTRODUCTION: SARS-CoV-2 infection leads to a wide spectrum of clinical disease characterized by hyperinflammation. The role of eosinophils in SARS-CoV-2 infection is unclear, and rare eosinophilic complications have been reported. We present a case of severe hypereosinophilia developing concomitantly with SARS-CoV-2 infection, leading to multiple end-organ damage to the extent not previously described. CASE DESCRIPTION: 24-year-old female with bipolar disorder presented with neck/throat and muscle pain in January of 2021, during an Omicron variant wave of SARS-CoV-2. Initial testing detected positive SARS-CoV-2 PCR, leukocytosis 37.7 × 10(3)/μL and eosinophilia 24.39 × 10(3)/μL. Over the next month, patient's leukocytes and eosinophils persistently increased to maximum 96.5 and 71.5 × 10(3)/μL respectively. She developed muscle weakness and vision changes. Physical exam showed forearm edema, tremors, and splinter hemorrhages. Imaging confirmed myocarditis, multiple strokes, with regional myositis, cellulitis, and tenosynovitis. Lab workup was negative for other infections, ANCA vasculitides, KIT-mutation, tryptase, vitamin B12, FISH panel for myeloproliferative disorders, and next generation sequencing (PDGFRA, PDGFRB, FGFR1, FGFR2, JAK2). Bone marrow biopsy demonstrated leukocytosis, absolute eosinophilia with reactive features. She was treated with hydroxyurea and systemic steroids, after which the eosinophil count declined and she started to note clinical improvement. At this time, she has successfully transitioned to mepolizumab monotherapy. DISCUSSION: Hypereosinophilia and eosinophilic inflammation have been described following SARS-CoV-2 infection and vaccination. Hypereosinophilia can inflict end-organ damage, but to our knowledge this is the first reported case of severe hypereosinophilia coinciding with COVID-19, causing this extensive degree of systemic thrombotic and myopathic disease. Whether SARS-CoV-2 infection was a coincidental or causative, remains uncertain.