Large Apical Thrombus in a Patient with Persistent Heart Failure and Hypereosinophilia: Löffler Endocarditis

Abstract

Idiopathic hypereosinophilic syndrome is an uncommon leukoproliferative systemic disorder characterized by the overproduction of eosinophils and poor prognosis. A major source of morbidity and mortality of this syndrome is the associated cardiac involvement represented by endocardial thickening and mural thrombi. We report a 64-year-old woman with persistent symptoms of heart failure despite standard medical therapy. Echocardiography revealed reduced left ventricular filling due to a large apical mass; an abnormal diastolic filling pattern was also noticed. Complete blood count revealed remarkable hypereosinophilia. Cardiac magnetic resonance imaging demonstrated an apical thrombus and intense linear enhancement of the endocardium, which were compatible with Löffler endocarditis. Medical therapy, including corticosteroids and anticoagulation, was initiated promptly. The symptoms improved as the peripheral hypereosinophilia resolved in 15 days. The patient was asymptomatic at the 1-year follow-up visit with complete regression of the apical thrombus and no evidence of restrictive cardiomyopathy. We report this case to draw attention to this particularly rare condition with poor prognosis since quick and accurate diagnosis and prompt initiation of therapy may improve symptoms and survival.

Löffler endocarditis: a rare cause of acute cardiac failure

“…These are blood eosinophilia of >1500 cells per microliter for more than six consecutive months, absence of an underlying cause of hypereosinophilia despite extensive diagnostic evaluation, and organ damage or dysfunction as a result of local release of the toxic contents of eosinophils [1]. HES affects mostly men between 20 and 50 years of age, with a peak in the 4 th decade of life [3,4]. There are no published data regarding its incidence/prevalence, although the syndrome is considered rare in adults and very rare in children.…”

Οι Καρκινικοί Δείκτες Στη Διάγνωση Και Παρακολούθηση Ασθενών Με Αιματολογικές Κακοήθειες

“…Παγκοσμίως, οι παρασιτικές ασθένειες συνιστούν την πιο κοινή αιτία, ενώ στις ανεπτυγμένες χώρες, οι αλλεργικές ασθένειες είναι περισσότερο συχνές. Άλλες αιτίες περιλαμβάνουν κακοήθειες (μεταστατικό καρκίνο, λέμφωμα των Τ-κυττάρων, καρκίνο του παχέως εντέρου), σύνδρομο Löffler, σύνδρομο Churg-Strauss, αλλεργική βρογχοπνευμονική ασπεργίλλωση, διαταραχές του συνδετικού ιστού (σκληρόδερμα, οζώδη πολυαρτηρίτιδα), ασθένειες του δέρματος (ερπητοειδή δερματίτιδα), φλεγμονώδη νόσο του εντέρου, σαρκοείδωση και νόσο του Addison [105], [106] .…”

“…Η κλωνική ηωσινοφιλία διαγιγνώσκεται με την ιστολογική εξέταση του μυελού των οστών, την κυτταρογενετική και την μοριακή βιολογία και περιλαμβάνει τα ακόλουθα [106] :…”