Case report: Different clinical manifestations of the rare Loeffler endocarditis

Zhao, Yuanyuan; Pei-qing, Jiang; Chen, Xiangyun; Yao, Guihua

doi:10.3389/fcvm.2022.970446

Cited by 4 publications

(4 citation statements)

References 18 publications

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“…This is the first presentation of the rationale for the MDT in eosinophilia ( Supplementary Tables 1, 2 ; Table 1 and Figures 2 – 4 ). The MDT function is a well-established tool across medical disciplines ( 172 – 177 ), and MDTs have been implemented in departments treating eosinophilic esophagitis, possibly improving patient outcomes ( 180 , 181 ), and have also been considered in Loeffler’s endocarditis ( 182 ). However, one difference between the MDT for patients with eosinophilia and other scheduled MDTs is that the MDT for eosinophilia typically starts by challenging and discussing the working diagnosis ( Figure 5 ), whereas the diagnosis has been established unquestionably in (almost all referred patients) MDTs.…”

Section: Discussionmentioning

confidence: 99%

The multidisciplinary approach to eosinophilia

et al. 2023

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Eosinophilic granulocytes are normally present in low numbers in the bloodstream. Patients with an increased number of eosinophilic granulocytes in the differential count (eosinophilia) are common and can pose a clinical challenge because conditions with eosinophilia occur in all medical specialties. The diagnostic approach must be guided by a thorough medical history, supported by specific tests to guide individualized treatment. Neoplastic (primary) eosinophilia is identified by one of several unique acquired genetic causes. In contrast, reactive (secondary) eosinophilia is associated with a cytokine stimulus in a specific disease, while idiopathic eosinophilia is a diagnosis by exclusion. Rational treatment is disease-directed in secondary cases and has paved the way for targeted treatment against the driver in primary eosinophilia, whereas idiopathic cases are treated as needed by principles in eosinophilia originating from clonal drivers. The vast majority of patients are diagnosed with secondary eosinophilia and are managed by the relevant specialty—e.g., rheumatology, allergy, dermatology, gastroenterology, pulmonary medicine, hematology, or infectious disease. The overlap in symptoms and the risk of irreversible organ involvement in eosinophilia, irrespective of the cause, warrants that patients without a diagnostic clarification or who do not respond to adequate treatment should be referred to a multidisciplinary function anchored in a hematology department for evaluation. This review presents the pathophysiology, manifestations, differential diagnosis, diagnostic workup, and management of (adult) patients with eosinophilia. The purpose is to place eosinophilia in a clinical context, and therefore justify and inspire the establishment of a multidisciplinary team of experts from diagnostic and clinical specialties at the regional level to support the second opinion. The target patient population requires highly specialized laboratory analysis and therapy and occasionally has severe eosinophil-induced organ dysfunction. An added value of a centralized, clinical function is to serve as a platform for education and research to further improve the management of patients with eosinophilia. Primary and idiopathic eosinophilia are key topics in the review, which also address current research and discusses outstanding issues in the field.

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Section: Discussionmentioning

confidence: 99%

The multidisciplinary approach to eosinophilia

et al. 2023

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“…15 Loeffler endocarditis can cause certain complications, such as systemic thromboembolic events, progressive heart failure, arrhythmias, and sudden cardiac death. [16][17][18] In this in-depth review, we discuss the epidemiology, etiology, pathophysiological mechanisms, staging, diagnosis, treatment and prognosis of Loeffler endocarditis. In addition, we share some relatively uncommon images obtained from patients with Loeffler endocarditis.…”

Section: Introductionmentioning

confidence: 99%

In-Depth Review of Loeffler Endocarditis: What Have We Learned?

Su,

Liang,

Lü

et al. 2024

JIR

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Loeffler endocarditis, eosinophilic endocarditis or eosinophilic endomyocardial disease are conditions associated with hypereosinophilia and they affect the heart function. Loeffler endocarditis is a rare endomyocardial disorder thought to be caused by eosinophilic damage. The disorder is characterized by inflammatory infiltration, formation of thrombus within cardiovascular system, and ultimately fibrosis of the afflicted area. It can lead to multiple severe complications, including thromboembolic disease, thickening of fibrous tissue in the endocardium of ventricles, valve involvement, apical obliteration, and various heart disorders. Although early clinical intervention can lead to remission, the underlying mechanisms of the disorder remain unresolved. In the present article, we summarise the existing literature concerning Loeffler endocarditis based on PubMed, Web of Science, and other medical databases to conduct an in-depth review of the epidemiology, etiology, pathophysiological mechanisms, staging, diagnosis, treatment and prognosis of Loeffler endocarditis. Meanwhile, we provide novel patients data and clinical figures of Loeffler endocarditis to supplement the understanding of this cardiac disorder. The findings presented in this article provide a basis for further studies and can be used to improve management of the disorder.

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“…Cardiac involvement in Loeffler syndrome results in endocardial thickening, atrial dilatation, and a restrictive pattern from eosinophil degranulation, resulting in diastolic dysfunction on echocardiography. These findings are occasionally accompanied by echogenic fibrosis or thrombosis, frequently located in the apical region of the left and right ventricles, resulting in ventricular obliteration [ 1 , 4 ].…”

Section: Introductionmentioning

confidence: 99%

“…The data regarding Loeffler syndrome and its prognosis are scarce [ 3 ]. Early diagnosis and management are important in management, and there is no consensus or set of guidelines available for managing Loeffler syndrome [ 4 ]. We present a case of Loeffler syndrome in a 65-year-old patient who presented with septic shock and was treated with antibiotics and low molecular weight heparin (LMWH) but unfortunately succumbed to the disease.…”

Section: Introductionmentioning

confidence: 99%

Hypereosinophilic Syndrome Endocarditis With Severe Biventricular Failure Complicated by Sepsis: A Challenging Case

Khan,

Pabani

2023

Cureus

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Hypereosinophilic syndrome (HES) is a myeloproliferative disorder characterized by persistent hypereosinophilia that is associated with multi-organ damage. Eosinophilic endocarditis is a serious complication of HES. The exact prevalence of the disease is unknown, and it is characterized by a persistently elevated eosinophil count, resulting in multi-organ involvement due to eosinophilic infiltration. We present a case of a 65-year-old Caucasian male patient who presented with one-week symptoms of feeling unwell and intermittent pleuritic chest pain. His medical history was significant for the idiopathic hypereosinophilic syndrome, eosinophilic myocarditis, hypertension (HTN), type 2 diabetes mellitus (T2DM), and chronic obstructive pulmonary disease (COPD). Inflammatory markers were raised, including eosinophil count, and a transthoracic echocardiogram (TTE) showed a mass attached to the mitral valve (MV) leaflets, suggesting vegetation or thrombus. The patient was commenced on intravenous antibiotics, inotropes for septic shock, and low molecular weight heparin (LMWH) for a possible thrombus. He showed mild biochemical improvement initially without any clinical improvement before further deterioration secondary to aspiration pneumonia. He was seen by the palliative care team and mental health team for confusion and agitation and was put on the palliative care pathway. All active medical treatment was stopped, and the patient succumbed to his illness three weeks into his admission.

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Case report: Different clinical manifestations of the rare Loeffler endocarditis

Cited by 4 publications

References 18 publications

The multidisciplinary approach to eosinophilia

The multidisciplinary approach to eosinophilia

In-Depth Review of Loeffler Endocarditis: What Have We Learned?

Hypereosinophilic Syndrome Endocarditis With Severe Biventricular Failure Complicated by Sepsis: A Challenging Case

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