Echocardiographic Changes in Eosinophilic Endocarditis Induced by Churg-Strauss Syndrome

Abstract

Eosinophilic myocarditis may be accompanied by Churg-Strauss syndrome (CSS). We report a case of CSS that was accompanied by myocardial changes in the early stage. A 71-year-old woman complained of mild chest pain at rest, but routine echocardiography did not reveal any endocardial abnormalities. Four months later, the patient was hospitalized due to congestive heart failure with neuropathy of both upper extremities. A diagnosis of eosinophilic myocarditis was made based on the patient's laboratory results and the presence of mural thrombus. This case illustrates that, although early eosinophilic myocarditis is an important differential diagnosis in patients with chest pain, it may be difficult to identify in without an apparent mural thrombus.

Role of Inflammatory Cell Subtypes in Heart Failure

“…Binding of IgE antigen complexes and phagocytosis, release of granules with hydrolases, cationic and basic proteins toxic to the heart, and endothelial cells are capable of activating platelets by binding thrombomodulin [87]. In sustained eosinophilia, the accumulation of eosinophils in the interstitial compartment of the heart is deleterious to cardiac tissue and involves thrombus formation, thickening, and fibrosis of the endocardium [88]. There are some case reports of PAH in hypereosinophilic syndromes [89].…”

Severe mitral stenosis secondary to eosinophilic granulomatosis resolving after pharmacological treatment

“…Intraventricular thrombi are much more frequently detected on MRI than on echocardiography . Usually, a thrombus formed due to cardiac involvement in EGPA responds well to immunosuppressive and antithrombotic treatment . In the related literature, there are a few cases in which, despite antithrombotic treatment, the thrombus did not dissolve .…”

“…16 Usually, a thrombus formed due to cardiac involvement in EGPA responds well to immunosuppressive and antithrombotic treatment. 17,18 In the related literature, there are a few cases in which, despite antithrombotic treatment, the thrombus did not dissolve. 19 Thromboembolic risk and indications for antithrombotic treatment in presented case were additionally supported by the decompensation of heart failure, 20 and presence of severe mitral stenosis.…”

The Critical Role of Cardiac Magnetic Resonance Imaging in Evaluating Patients With Eosinophilic Granulomatosis With Polyangiitis

“…The evaluation of the cardiovascular system in EGPA patients involves the use of many imaging techniques including ECG, computed tomography angiography (CTA), and CMR [23]. The EGPA Consensus Task Force has stated that the use of advanced imaging techniques showed more sensitivity in detecting cardiac involvement [24].…”