Loeffler’s Endocarditis and Hypereosinophilic Syndrome

Salih, Mohammed; Ibrahim, Ramzi; Tirunagiri, Deepthi; Al-Ani, Hadeel; Ananthasubramaniam, Karthikeyan

doi:10.1097/crd.0000000000000324

Cited by 9 publications

(27 citation statements)

References 78 publications

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“…Loeffler's endomyocarditis is considered when there is isolated myocardial involvement. Congestive heart failure and extensive myocardial involvement are seen in the majority of the patients [22]. In the current study, eosinophilic infiltration was not observed in the histopathological evaluation of other organs.…”

Section: Discussioncontrasting

confidence: 52%

Eosinophilic myocarditis from a forensic histopathological perspective

Gün

Buğra

2023

Journal of Forensic Sciences

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Eosinophilic myocarditis (EM) is a rare and potentially fatal form of myocarditis characterized by infiltration of the myocardium with eosinophil leukocytes, often accompanied by eosinophilia. Although the exact underlying cause remains unknown, it has been shown to be associated with hypersensitivity reactions, immune‐mediated disorders, infections, or cancer. Due to the differences in symptomatology, it is often diagnosed by postmortem histopathological examination. We aimed to retrospectively examine the histopathological findings of rare cases of EM and to detect accompanying cardiac and other organ pathologies. The histopathological findings of the cases that underwent autopsies between 2012 and 2020 and were diagnosed with EM were assessed. Demographic features, symptoms, causes of death, macroscopical findings at autopsy, toxicologic and microbiological analysis results, accompanying cardiac pathologies, and histopathological findings in other organs were evaluated. Myocarditis was detected on histopathologic examination in 558 (1.1%) of 49,612 forensic autopsies. There were 12 (2.3%) EM cases. There were nine males and four females. The mean age was 42.3 (3–83) years. Heart weights ranged from 82 to 564 g. The most common finding on macroscopic examination was the mottled discoloration and scarring in the myocardium. Microscopic examination revealed perivascular and interstitial infiltration of eosinophils in all of the cases accompanied by myocyte necrosis in four of them. EM was reported as the cause of death in four cases. EM remains a challenging heart disease with its obscure etiopathogenesis and varying clinical presentation and a rare entity diagnosed by postmortem histopathological examination in sudden and unexpected deaths.

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Section: Discussioncontrasting

confidence: 52%

Eosinophilic myocarditis from a forensic histopathological perspective

Gün

Buğra

2023

Journal of Forensic Sciences

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“…Endomyocardial biopsy is the gold standard for diagnosing Loeffler endocarditis ( 14 ); however, no clinical guidelines for managing Loeffler endocarditis are currently in vogue, and treatment expertise is mostly derived from a handful of previous case reports. The management of Loeffler endocarditis requires consideration of the etiology of eosinophilia, the stage of progress, and the involvement of organs ( 3 ). The treatment goals should include the following: (1) eosinophils being reduced to the normal range to avoid cardiac damage (eosinophils can release toxic substances), and (2) treatment of the underlying etiology and complications (heart failure, arrhythmia, thrombus).…”

Section: Discussionmentioning

confidence: 99%

“…Consequently, early identification and effective treatment are crucial for improving the prognosis. However, no consensus guidelines are available for managing Loeffler endocarditis ( 3 ), because the management treatment of each patient is individualized and relates to (1) an acute treatment, (2) a symptomatic cardiac treatment based on diverse manifestations (anti-arrhythmics, pressure support, ejection fraction support (EF support), thrombus targeting, prophylaxis, etc. ), and (3) finally a thorough diagnostic workup to identify the cause of eosinophilia (idiopathic, primary, or secondary).…”

Section: Introductionmentioning

confidence: 99%

Case report: Different clinical manifestations of the rare Loeffler endocarditis

Zhao

Pei-qing

Chen

et al. 2022

Front. Cardiovasc. Med.

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BackgroundLoeffler endocarditis is a rare and fatal disease, which is prone to be misdiagnosed, owing to its various clinical manifestations. Consequently, an early identification of Loeffler endocarditis and its effective treatment are crucial steps to be undertaken for good prognosis.Case presentationThis report describes two cases of Loeffler endocarditis with different etiologies and clinical manifestations. Case 1 was caused by idiopathic eosinophilia and presented with a thrombus involving the tricuspid valve and right ventricular inflow tract (RVIT). The patient suffered from recurrent syncope following activity. After the patient underwent tricuspid valve replacement and thrombectomy, he took oral prednisone and warfarin for 2 years, consequent to which he discontinued both drugs. However, the disease recurred 6 months later, this time manifesting as edema of both legs. Echocardiography showed that a thrombus had reappeared in the RVIT. Thus, oral prednisone and warfarin therapy was readministered. Three months later, the thrombus had dissolved. Low-dose prednisone maintenance therapy was provided long term. Case 2 involved a patient who presented with recurrent fever, tightness in the chest, and asthma, and whose condition could not be confirmed, despite multiple local hospitalizations. In our hospital, echocardiography revealed biventricular apical thrombi. After comprehensive examinations, the final diagnosis was eosinophilic granulomatosis polyangiitis (EGPA) involving multiple organs, including the heart (Loeffler endocarditis), lungs, and kidneys. After administration of corticosteroid, anticoagulant, and immunosuppressive agents along with drugs to improve cardiac function, the patient's symptoms improved significantly.ConclusionIn Loeffler endocarditis due to idiopathic eosinophilia, long-term corticosteroid use may be required. Diverse and non-specific symptoms cause Loeffler endocarditis to be easily misdiagnosed. So, when a patient shows a persistent elevation of the eosinophil count with non-specific myocardial damage, the possibility of this disease, should always be considered. Furthermore, even when an invasive clinical procedure such as endomyocardial biopsy (EMB) is not available or acceptable, corticosteroids should be administered promptly to bring the eosinophil count back to the normal range, thereby halting the progression of disease and reducing patient mortality.

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“…Studies have reported that approximately 60% of patients with IHES suffer from heart damage ( Ogbogu et al, 2007 ; He et al, 2020 ). Cardiac involvement secondary to IHES was reported to be the leading cause of death ( Ogbogu et al, 2007 ; He et al, 2020 ; Salih et al, 2021 ). Cardiac injury caused by HES occurs in three stages ( He et al, 2020 ).…”

Section: Discussionmentioning

confidence: 99%

Case report: Application of non-VKA oral anticoagulants in patient of idiopathic hypereosinophilic syndrome with intracardiac thrombus

Zou

Liu

2022

Front. Pharmacol.

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Idiopathic hypereosinophilic syndrome (IHES) is a rare but life-threatening disease related to a group of myeloproliferative disorders characterized by prolonged eosinophilia of unknown cause and inflammatory damage to multiple organs. Here, we present a 44-year-old female patient complaining of shortness of breath and palpitations for 1 month. Her history and presentation were unremarkable, except for a 3-years history of rheumatoid arthritis treated with ibuprofen (0.3 g per day). Initial examination showed heart rate (HR) 120 bpm, respiratory rate (RR) 20 bpm, temperature (T) 36°C, blood pressure (BP) 130/70 mmHg, ventricular gallop rhythm, rales at the lung bases, soft abdomen, nonpalpable liver and spleen, and slight edema in both lower extremities. Bone marrow aspirate and biopsy confirmed the diagnosis of IHES, while cardiac MRI showed intracardiac thrombus. The symptoms of shortness of breath and palpitation disappeared, the eosinophil counts in routine blood tests were normal, and the thrombus in the cardiac cavity gradually disappeared after combined therapy of anti-hypereosinophilic, anti-coagulant and anti-heart failure treatments.

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Loeffler’s Endocarditis and Hypereosinophilic Syndrome

Cited by 9 publications

References 78 publications

Eosinophilic myocarditis from a forensic histopathological perspective

Eosinophilic myocarditis from a forensic histopathological perspective

Case report: Different clinical manifestations of the rare Loeffler endocarditis

Case report: Application of non-VKA oral anticoagulants in patient of idiopathic hypereosinophilic syndrome with intracardiac thrombus

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