WCC 2016-101: A Rare Case of Endomyocardial Fibrosis with Sub-Valvular Thickening

Abstract

A 35 year old female presented with puffiness of face and swelling of both lower limbs since 15 days. On examination JVP is raised, P.R-80/min,BP-90/60 mm of Hg .there are grade III parasternal pulsations and epigastric pulsations. Loud P2, ESM in left 2nd intercoastal space.pan-systolic murmur in mitral area and mid-diastolic murmur .she was diagnosed to have chronic rheumatic heart disease and kept on treatment but the symptoms worsened so she was further evaluated where the Absolute eosinophil count 74,128. Negative for anti-nuclear antibodies negative for p210, 190, p230 transcripts, and on fluorescence insitu hybridization it is negative. Trephine biopsy showed marrow eosinophilia. So hematological malignancies are excluded, chest x-ray -cardiomegaly .2D Echo Showed thickened moderator band, endocardial plaques in the left ventricle, sub -mitral thickening, with increased sub -mitral gradients and mild mitral regurgitation. Cardiac MRI showed endocardial plaques with sub-valvular thickening. She was started on prednisolone where her symptoms got improved and discharged in a stable condition