Nasser Rashid Dar, Sajid Mustafvi, Khalid Khalique, Amjad Sharif, Shahid Majeed.
Recurrent urticaria, blood eosinophilia and eosinophilic ascites – a new varient of Gleich`s syndrome.
Pak Armed Forces Med J Jan ;58(3):340-2.

A 30-year-old male presented with recurrent attacks of urticaria for the last two years. Examination revealed ascities which was tapped and analysis reveald an exudative picture with more than 80% cells being eosinophils. His blood showed a leukocytosis of 22.3 x 103/l with 64% eosinophilis.Haemoglobulin and platelets were within normal limits and no abnormal cells were seen in peripheral blood picture. He did not respond to H1 and H2 histamine receptor blockers so he was started on parenteral steroids He rapidly responded to the treatment with resolution of ascities and disappearance of abdominal pain and resolution of urticaria. There was normalization of his leukocyte count and his absolute eosinophil count fell to 465/cmm. The steroids were tapered off and he was discharged from the hospital symptom free. Two years latter in March 2006 he was again admitted with complaints of urticaria, and abdominal pain. Bone marrow studies showed a hypercellular bone marrow with hyperplastic myelopoeisis showing normal maturation and increased eosinophils / eosinophil precursors. Grade 1 fibrosis was also observed. Cytogenetic analysis did not reveal structural or numerical chromosomal abnormality. Serum immunoglobulin estimation revealed IgA 3.6 g/l (0.8- 4.0 g/l), IgG 14.5 (5.3-16.5 g/l) and IgM 0.53 g/l (0.5-2.0 g/l). Serum LDH level was 1329 U/l (230-460 u/l). The patient was treated with parenteral and oral steroids. All of his symptoms resolved with normalization of blood counts. The patient was discharged from the hospital with instructions for regular follow up of eosinophil count and to report back if the symptoms recur.

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