A 40-year-old woman, who was diagnosed with hypereosinophilic syndrome, was admitted on multiple occasions for angioedema of face, throat, hands, and legs, diffuse abdominal pain, and urticarial edematous plaques on her arms, trunk, and thighs. She complained of itching and then burning pain in skin lesions which persisted for 2-3 days and recurred episodically. Acute symptoms were controlled with high dose oral steroids and antihistamines. The hypereosinophilic syndromes are a heterogeneous group of disorders characterized by three common features: peripheral eosinophil count of > 1500/µL for longer than six months, evidence of end organ involvement (excluding benign eosinophilia), and absence of other causes of eosinophilia (drugs, parasites, malignancy). Skin involvement is seen in 50% of patients. Typical cutaneous features include urticaria and angioedema as well as fixed urticarial papules and plaques. Treatment of the eosinophilia usually results in improvement in cutaneous and systemic symptoms.
scattered widely disseminated 0.5-1.5 cm red plaques with dusky centers