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Eosinophils are predominantly tissue-dwelling cells (spleen, lymph nodes, thymus, digestive tract) and counts <500/mm3 in the peripheral blood are considered to be normal. The functions of eosinophils are not completely understood, however there can be a significant rise in their levels in the peripheral blood and/or tissues in a variety of disease states. Hypereosinophilic syndromes (HES) are a group of disorders characterised by blood eosinophilia greater than 1500/mm3 on at least two occasions and eosinophilic infiltration and damage to multiple organs. Eosinophils on activation release substances that can lead to tissue damage. However, it is important to note that the degree of tissue damage is not directly proportional to the level of eosinophilia. A significant number of cases of HES are commonly missed and therefore a systematic approach is necessary for all such patients. Through our case, we have tried to summarise how to systematically approach a case of HES and manage it., (© Journal of the Association of Physicians of India 2011.)