Loeffler Endocarditis: A Manifestation of Hypereosinophilic Syndrome

Arustamyan, Michael; Hoosain, Jamael; Mattson, Jennifer; Hasni, Syed Farhan; Cho, Sung-Hae; Kiliddar, Paulina Gorodin

doi:10.1016/j.case.2019.10.008

Cited by 5 publications

(5 citation statements)

References 7 publications

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“…Loeffler endocarditis is a rare condition related to hypereosinophilia. It is charac-terized by endomyocardial infiltration by degranulated eosinophils, consequent fibrosis, and thickening of the endocardium, along with a restriction of diastolic filling [68].…”

Section: Differential Diagnosis Of Myocarditis Associated With Peripheral Eosinophiliamentioning

confidence: 99%

“Heart in DRESS”: Cardiac Manifestations, Treatment and Outcome of Patients with Drug Reaction with Eosinophilia and Systemic Symptoms Syndrome: A Systematic Review

Radovanovic

Jevtic

Calvin

et al. 2022

JCM

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Cardiac involvement in drug reaction with eosinophilia and systemic symptoms (DS) is rare but associated with high mortality. The aim of this research was to systematically review case reports by PRISMA guidelines in order to synthetize the knowledge of cardiac manifestations of DS. We identified 42 cases from 36 case reports. Women were two times more affected than men. Two-thirds of patients had cardiac manifestation in the initial phase of the disease, while in one-third of cases cardiac manifestations developed later (mean time of 70 ± 63 days). The most common inciting medications were minocycline (19%) and allopurinol (12%). In 17% of patients, the heart was the only internal organ affected, while the majority (83%) had at least one additional organ involved, most commonly the liver and the kidneys. Dyspnea (55%), cardiogenic shock (43%), chest pain (38%), and tachycardia (33%) were the most common cardiac signs and symptoms reported. Patients frequently had an abnormal ECG (71.4%), and a decrease in left ventricular ejection fraction was the most common echocardiographic finding (45%). Endomyocardial biopsy or histological examination at autopsy was performed in 52.4%, with the predominant finding being fulminant eosinophilic myocarditis with acute necrosis in 70% of those biopsied. All patients received immunosuppressive therapy with intravenous steroids, while non-responders were more likely to have received IVIG, cyclosporine, mycophenolate, and other steroid-sparing agents (60%). Gender and degree of left ventricular systolic dysfunction were not associated with outcomes, but short latency between drug exposure and the first DRESS symptom onset (<15 days) and older age (above 65 years) was associated with death. This underscores the potential importance of heightened awareness and early treatment.

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Section: Differential Diagnosis Of Myocarditis Associated With Peripheral Eosinophiliamentioning

confidence: 99%

“Heart in DRESS”: Cardiac Manifestations, Treatment and Outcome of Patients with Drug Reaction with Eosinophilia and Systemic Symptoms Syndrome: A Systematic Review

Radovanovic

Jevtic

Calvin

et al. 2022

JCM

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“…However, early detection and exhaustive evaluation in order to ascertain multiple organ involvement is crucial for the patient in the era of TKI treatment [31]. Relapsing after a period of reduced dose or after stopping the treatment highlights the idea that imatinib has a suppressive effect over the gene, rather than determining its abolition [6]. Following TKI treatment, a 5-year survival rate of 93.5% was reported in a single Chinese center [9].…”

Section: Discussionmentioning

confidence: 99%

“…Persistent eosinophilia in the blood flow leads to infiltrative lesions affecting various territories (heart, lungs, liver, skin, etc. ), which result in different degrees of dysfunction or secondary complications [3][4][5][6]. Cardiac involvement, known as Loeffler disease, alters the structure of the endothelium and is associated with a high probability of intracardiac thrombus formation.…”

Section: Introductionmentioning

confidence: 99%

FIP1L1–PDGFRα-Positive Loeffler Endocarditis—A Distinct Cause of Heart Failure in a Young Male: The Role of Multimodal Diagnostic Tools

Varga

Moldovan²,

Pop

et al. 2023

Diagnostics

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The presence of the Fip1-Like1-platelet-derived growth factor receptor alpha (FIP1L1–PDGFRα) fusion gene represents a rare cause of hypereosinophilic syndrome (HES), which is associated with organ damage. The aim of this paper is to emphasize the pivotal role of multimodal diagnostic tools in the accurate diagnosis and management of heart failure (HF) associated with HES. We present the case of a young male patient who was admitted with clinical features of congestive HF and laboratory findings of hypereosinophilia (HE). After hematological evaluation, genetic tests, and ruling out reactive causes of HE, a diagnosis of positive FIP1L1–PDGFRα myeloid leukemia was established. Multimodal cardiac imaging identified biventricular thrombi and cardiac impairment, thereby raising suspicion of Loeffler endocarditis (LE) as the cause of HF; this was later confirmed by a pathological examination. Despite hematological improvement under corticosteroid and imatinib therapy, anticoagulant, and patient-oriented HF treatment, there was further clinical progression and subsequent multiple complications (including embolization), which led to patient death. HF is a severe complication that diminishes the demonstrated effectiveness of imatinib in the advanced phases of Loeffler endocarditis. Therefore, the need for an accurate identification of heart failure etiology in the absence of endomyocardial biopsy is particularly important for ensuring effective treatment.

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“…Clinical signs and symptoms include fever, weight loss, rash, symptoms of heart failure and arrhythmias. [ 5 , 6 ]…”

Section: Introductionmentioning

confidence: 99%

A Case Report of Colonoscopy-Induced Splenic Laceration: Risks and Outcomes

Rafa¹,

Campeas²,

Basile³

2021

AJMCR

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Löffler endocarditis is an uncommon, but known complication of hypereosinophilic syndrome (HES). It is a relatively rare entity, and remains poorly understood. To this point in time, the compendium of knowledge about this disease consists of various case reports, prospective studies and review articles. We aim to present a scoping study about this disease. Our goals are to identify the characteristic features found in case reports to identify characteristic features found in patients with Löffler endocarditis as a result of hypereosinophilic syndrome. An analysis of the 26 case reports showed a mean age of 41.6 years with a standard deviation of 17.1 years. Dyspnea was the most common presenting complaint (64%) followed by fatigue (23%), cough (19%), fever (19%), orthopnea/paroxysmal nocturnal dyspnea (19%), stroke related symptoms (15%), chest pain (15%) and lower extremity edema (15%). The most common cardiac structure affected was the mitral valve (65%), followed by the tricuspid valve (42%), left ventricle (23%), with 35% of cases having involvement of two valves. The most common therapeutic modality was immunosuppression (85%), followed by anticoagulation (73%) and mitral valve replacement (23%). Death was reported in 19% of the cases. Löffler’s endocarditis continues to be associated with high morbidity and mortality. Further research must aim to develop guidelines for management of this uncommon manifestation of hypereosinophilic syndrome.

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Loeffler Endocarditis: A Manifestation of Hypereosinophilic Syndrome

Cited by 5 publications

References 7 publications

“Heart in DRESS”: Cardiac Manifestations, Treatment and Outcome of Patients with Drug Reaction with Eosinophilia and Systemic Symptoms Syndrome: A Systematic Review

“Heart in DRESS”: Cardiac Manifestations, Treatment and Outcome of Patients with Drug Reaction with Eosinophilia and Systemic Symptoms Syndrome: A Systematic Review

FIP1L1–PDGFRα-Positive Loeffler Endocarditis—A Distinct Cause of Heart Failure in a Young Male: The Role of Multimodal Diagnostic Tools

A Case Report of Colonoscopy-Induced Splenic Laceration: Risks and Outcomes

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