A 32-year-old Pakistani man without significant comorbidity presented to the Emergency Department with generalized edema. Physical examination highlighted lower limbs and scrotum swelling with tense-elastic, indolent, bilateral retroauricular masses (Fig. 1a). Blood tests showed severe peripheral eosinophilia (WBC 9500/μL, E 2650/μL, confirmed by peripheral blood smear), high levels of IgE (7710U/mL), severe hypoalbuminemia (1.2g/dL), dyslipidemia (LDL cholesterol 266mg/dL) with mild renal impairment (eGFR 40mL/min/1.73m2).
