Persistently elevated eosinophil granulocytes in the peripheral blood in children is challenging due to a complex diagnosis especially after solid organ transplantation and can lead to difficulties in finding an underlying causative factor. We report a 12-year-old boy who developed severe hypereosinophilia eleven years after liver transplantation (LT) due to biliary atresia. Accompanying symptoms were recurrent fever, fatigue, elevated liver enzymes, abdominal pain and significant weight loss. After exclusion of secondary causes of eosinophilia, an idiopathic hypereosinophilic syndrome (I-HES) was diagnosed. Treatment with prednisolone resulted in an immediate response with rapid reduction of eosinophils, normalization of liver enzymes and amelioration of any clinical symptoms. A hypereosinophilic syndrome in patients after LT is rare and a broad differential diagnosis has to be considered. Prednisolon may lead to a prompt amelioration of eosinophilia and associated symptoms. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.
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