Fulminant idiopathic hypereosinophilic syndrome presenting with cardiac, neurologic and haematologic involvement

Maintain suspicion for HES in unexplained eosinophilia with multi-organ dysfunction.Eosinophilic myocarditis may present with high troponin despite normal echocardiogram.Bilateral watershed infarcts reflect microvascular hypoperfusion due to eosinophilic endothelial injury.Thrombocytopenia often resolves rapidly with corticosteroids.Early immunosuppression prevents irreversible organ damage.