Refractory pruritus in end-stage prostatic adenocarcinoma: an unusual presentation of a hypereosinophilic syndrome

Authors

• Luca Lo Russo Palliative and Supportive Care Clinic, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
• Manuel Vittorio Bovello Palliative and Supportive Care Clinic, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
• Mattia Cavagna Palliative and Supportive Care Clinic, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
• Micaela Mare Palliative and Supportive Care Clinic, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
• Clarissa Caimi Palliative and Supportive Care Clinic, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
• Tanja Fusi-Schmidhauser Palliative and Supportive Care Clinic, Ente Ospedaliero Cantonale, Bellinzona, Switzerland; Department of Internal Medicine, Ospedale Regionale di Lugano, Ente Ospedaliero Cantonale, Lugano, Switzerland; Faculty of Medicine, University of Geneva, Switzerland; Department of Rehabilitation and Geriatrics, University of Geneva, Switzerland

manuelbovello@gmail.com

Keywords

Abstract

Introduction: Hypereosinophilic syndrome (HES) associated with advanced adenocarcinoma of the prostate is an exceptionally rare paraneoplastic condition. Available evidence suggests that eosinophilia may correlate with tumour progression and poor prognosis. Cutaneous manifestations, including severe pruritus and angioedaema, may significantly impair quality of life and represent particularly challenging symptoms in a palliative care setting. Pruritus management requires individualised multidisciplinary approaches including corticosteroids, antihistamines, gabapentinoids, antidepressants, opioid modulation and supportive care measures. In refractory cases, severe pruritus associated with HES may become a source of profound suffering and in end-of-life care may require palliative sedation to relieve otherwise intolerable distress.
Case description: We report the case of a patient with prostatic acinar adenocarcinoma who developed paraneoplastic HES, presenting with severe refractory pruritus and recurrent angioedaema. Despite multiple symptomatic treatments, the patient experienced progressive symptom burden with significant impairment in quality of life, ultimately requiring terminal palliative sedation during end-of-life care.
Conclusion: This case highlights the diagnostic challenges of HES, the importance of malignancy progression and the severe impact of uncontrolled eosinophil-mediated symptoms in advanced cancer.

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