Hyepereosiniphilic syndrome and COVID-19 pandemic: 2 case reports

Abstract

Background Nearly half of the patients with hypereosinophilic syndrome (HES) have cardiovascular involvement, a major cause of mortality. COVID-19 infection can lead to cardiac involvement, negatively impacting the clinical course and prognosis. We reported two cases of HES with cardiac involvement resulting in valve replacement, which were complicated by COVID-19. Case presentation: Our first case was a 27-year-old woman admitted due to dyspnea and signs of heart failure. An echocardiogram revealed severe mitral stenosis and mitral regurgitation. Corticosteroid therapy resulted in the improvement of her symptoms. However, she deteriorated during her hospital course following a positive COVID-19 test. A repeated echocardiogram showed right ventricular failure with severe mitral regurgitation and torrential tricuspid regurgitation. Therefore, she underwent mitral and tricuspid valve replacement. Our second case was a 43-year-old man with HES resulted in severe tricuspid stenosis. Corticosteroid treatment improved tricuspid stenosis, but he underwent valve replacement due to severe valvular regurgitation. He was admitted following tricuspid prosthetic valve thrombosis. Initial workups revealed lung involvement in favor of COVID-19 infection, and his PCR test was positive. Conclusion COVID-19 pandemic can change the clinical course of HES. It may result in a heart failure exacerbation due to myocardial injury and an increased risk of thrombosis in prosthetic valves or native vessels due to hypercoagulability.