Loffler's Endocarditis Presenting in 2 Children as Fever With Eosinophilia

Abstract

Hypereosinophilic syndromes are defined by the presence of peripheral and bone marrow eosinophilia and by the infiltration of multiple organs by mature eosinophilic cells. Loffler's endocarditis is a condition in which mature eosinophils infiltrate and damage the endocardium and myocardium. Male adults who live in the tropics are the population predominantly affected by this condition. Typical clinical features include weight loss, fever, cough, rash, and congestive heart failure. In this article, we report the typical presentation of an unusual illness that occurred in 2 pediatric patients in different geographic locations. In addition, we believe that these are the youngest patients with Loffler's endocarditis reported.

Hypereosinophilic Syndrome with Hepatic Involvement in a Young Child

“…The syndrome, which occurs mostly in middle-aged men, is characterized by striking peripheral blood eosinophilia. There have been few reports of the condition in patients younger than 15 years, and 91 -92% of patients are male, an overwhelming preponderance (3). Our case is unusual not only because of the patient's very young age, but also her gender.…”

Isoniazid-induced Drug Rash with Eosinophilia and Systemic Symptoms (DRESS) Syndrome Presenting as Acute Eosinophilic Myocarditis

“…HES, the pathogenesis of which remains unclear, has been reported to be involved in the onset of endocardial/cardiac diseases (8,9). There are numerous reports that antituberculosis medications may induce eosinophilia.…”

A Dobutamine paradox: eosinophilic myocarditis in the explanted heart of a 9-year-old girl undergoing cardiac transplantation

“…5 Secondly, eosinophilic myocarditis may be associated with conditions in which peripheral blood eosinophilia is present, such as Lofflers syndrome and parasitic infestations. 6 Thirdly, some cases are reported following an apparent clear history of precipitating viral infection, suggesting an uncommon immunological response to a common antigen, the pathogenesis of the cardiac dysfunction presumably being similar to lymphocytic post-viral myocarditis. 7 Finally, eosinophilic myocardial infiltration has also been reported in association with the use of intravenous dopamine/dobutamine as therapy for severe cardiac failure.…”