European Journal of Echocardiography Advance Access originally published online on April 5, 2007
European Journal of Echocardiography 2008 9(3):401-402; doi:10.1016/j.euje.2007.02.008
Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2007. For permissions please email: journals.permissions@oxfordjournals.org
Löffler's endocarditis: the hypereosinophic syndrome
Mohamad Ali Ostovan and
Amir Aslani*
Cardiology Department, Shiraz University of Medical Sciences, Namazee Hospital, P.O. Box 71935-1334, Shiraz, Iran
Received 10 December 2006; accepted after revision 14 February 2007; online publish-ahead-of-print 5 April 2007.
* Corresponding author. Tel: + 98 917 3156216; fax: + 98 711 6279733. E-mail address: draslani{at}yahoo.com
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Abstract
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In the present study we describe two similar severe cases of
Löffler's endocarditis in which eosinophilic infiltrations
obliterated the entire right ventricular cavity and caused severe
right ventricular dysfunction.
Keywords: Hypereosinophic; Syndrome; Löffler's endocarditis
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Illustration
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In the present study we describe two similar severe cases of
Löffler's endocarditis in which eosinophilic infiltrations
obliterated the entire right ventricular cavity and caused severe
right ventricular dysfunction.
Figure 1 illustrates transthoracic
echocardiography of a 51-year-old man admitted due to fever
of 38.9°C. He was well up to 3 months prior to the admission.
Then he developed progressive dyspnea on exertion. Physical
examination revealed elevated jugular vein pressure and congestive
hepatomegaly. Laboratory studies showed persistent eosinophilia
(2100 eosinophils/mm
3) with negative parasitological tests.
Electrocardiogram showed non-specific ST segment and T wave
abnormalities. The chest X-ray revealed cardiomegaly with no
pulmonary infiltrations. In transthoracic echocardiography severe
obliteration of the right ventricular cavity with marked thickening
of the left ventricular endocardium was seen. Moderate tricuspid
regurgitation was also detected. Prednisolone 60 mg/day with
warfarin 2.5 mg/day were started for the patient. Three months
later, the patient became asymptomatic and only mild right and
left ventricular endocardial thickening was seen on echocardiography.
Follow up echocardiography which was done 6 months after the
first echocardiography revealed normal left ventricular endocardium
with only mild endocardial thickening of the right ventricular
cavity.
Figure 2 illustrates transthoracic echocardiography
of a 24-year-old woman admitted because of tachypnea. She was
well up to 5 months prior to this admission. Then she developed
weight loss and lower extremity edema. Physical examination
revealed elevated jugular vein pressure, ascites and congestive
hepatomegaly. Laboratory studies showed persistent eosinophilia
(3200 eosinophils/mm
3) with negative parasitological tests.
The chest X-ray revealed cardiomegaly with some pulmonary infiltrations.
In transthoracic echocardiography complete obliteration of the
right ventricular cavity with left ventricular endocardial thickening
was seen.
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Figure 1 Transthoracic echocardiography of a 51-year-old man who was admitted because of fever and eosinophilia. (A) Apical 4-chamber view shows that right ventricular cavity is obliterated with an echo dense material and left ventricular endocardium is abnormally thickened. (B) Three months later, the patient became asymptomatic and only mild right and left ventricular endocardial thickening is seen. LV = left ventricle; LA = left atrium; RV = right ventricle; RA = right atrium.
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Figure 2 Transthoracic echocardiography of a 24-year-old woman who was admitted because of ascites and eosinophilia. (A) Apical 4-chamber view shows that right ventricular cavity is filled with an echo dense material and left ventricular endocardium is abnormally thickened. (B) Six months later, the patient became asymptomatic and only mild right and left ventricular endocardial thickening is seen. LV = left ventricle; LA = left atrium; RV =right ventricle; RA = right atrium.
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Moderate mitral and tricuspid regurgitation were also detected.
Prednisolone 60 mg/day with warfarin 5 mg/day were started for
the patient. Six months later, the patient became asymptomatic
and only mild right and left ventricular endocardial thickening
was seen on echocardiography. Follow up echocardiography which
was done 10 months after the first echocardiography revealed
normal left ventricular endocardium with only mild endocardial
thickening of the right ventricular cavity. Loffler's endocarditis
refers to the cardiac component of the hypereosinophilic syndromes.
In Löffler's endocarditis, mature eosinophils infiltrate
the endomyocardium and can lead to restrictive cardiomyopathy.
1 Atrioventricular valve insufficiency is the common echocardiographic
finding of this syndrome. Treatment with corticosteroids is
directed at diminishing the number of eosinophils and inhibiting
their localization, activation, and degranulation.
2
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References
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- Slungaard A, Vercellotti G, Tran T, Gleich GJ, Key NS. Eosinophil cationic granule proteins impair thrombomodulin function. A potential mechanism for thromboembolism in hypereosinophilic syndrome. J Clin Invest (1993) 91:1721–30.[Web of Science][Medline]
- Parrillo J, Borer J, Henry W, Wolff SM, Fauci AS. The cardiovascular manifestations of the hypereosinophilic syndrome. Prospective study of 26 patients, with review of the literature. Am J Med (1979) 67:572–81.[CrossRef][Web of Science][Medline]
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