Progression of left ventricular thrombus in Loeffler’s endocarditis without eosinophilia—case report and review of the literature

Published on Oct 1, 2019in Clinical Research in Cardiology4.907
· DOI :10.1007/s00392-019-01483-1
Michael Metze2
Estimated H-index: 2
Piroze M. Davierwala + 3 AuthorsTristan Klöter
  • References (31)
  • Citations (0)
#1Yuki KimuraH-Index: 5
#2Kenichi SasakiH-Index: 2
Last. Moriaki InokoH-Index: 13
view all 3 authors...
Abstract Loeffler’s endocarditis is cardiac damage mediated by hypereosinophilia with a poor prognosis. A 45-year-old woman with Loeffler’s endocarditis caused by eosinophilic granulomatosis with polyangiitis had hypereosinophilia (blood eosinophil count 32.4 × 10 9 /L) and left ventricular systolic and diastolic dysfunction (left ventricular ejection fraction 45%, e’ 5.1 cm/s). Echocardiography showed a left ventricular apical thrombus (32 × 30 mm). The cardiac magnetic resonance imaging scan s...
1 CitationsSource
#1Sunki Lee (KU: Korea University)H-Index: 7
#2C U ChoiH-Index: 17
Last. Jin Oh NaH-Index: 14
view all 4 authors...
1 CitationsSource
#1M. Gastl (HHU: University of Düsseldorf)H-Index: 3
#2P. Behm (HHU: University of Düsseldorf)H-Index: 3
Last. Florian Bönner (HHU: University of Düsseldorf)H-Index: 13
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Endocarditis parietalis fibroplastica Lofflein (EPF) is a rare form of primary restrictive cardiomyopathy with poor prognosis. It is generally caused by hypereosinophilic syndrome with eosinophilic penetration of the heart. This leads to congestive heart failure in three different stages. As a frequent manifestation of neoplastic diseases, cardiac involvement means poor prognosis. The present report deals with a case of EPF caused by non-specified T-cell lymphoma (T-NOS). Besides an elevated Tro...
1 CitationsSource
#1Grazia Casavecchia (University of Foggia)H-Index: 3
#2Matteo Gravina (University of Foggia)H-Index: 2
Last. Natale Daniele Brunetti (University of Foggia)H-Index: 21
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1 CitationsSource
#1Amit AlamH-Index: 3
#2Shankar ThampiH-Index: 1
Last. Rita JermynH-Index: 6
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Loeffler endocarditis is a rare restrictive cardiomyopathy caused by abnormal endomyocardial infiltration of eosinophils, with subsequent tissue damage from degranulation, eventually leading to fibrosis. Although an uncommon entity, it is still a disease with significant morbidity and mortality. Often identified only at late stages, treatment options are limited once fibrosis occurs, usually requiring heart failure medications or surgical intervention. We present a unique case of a woman with re...
2 CitationsSource
#1Wataru OmataH-Index: 3
#2Arata TsutsumidaH-Index: 14
Last. N. YamazakiH-Index: 1
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By the recent introduction of molecular targeting drugs against BRAF mutation and immune checkpoint inhibitors, the prognosis of patients with melanoma in advanced stage is now improving, but still in the minority. Mucosal melanoma lacks the BRAF mutations, and hence conventional chemotherapeutic regimens must be improved. We have conventionally used dacarbazine (DTIC) for patients with metastatic mucosal melanoma. However, the efficacy of DTIC in patients with metastatic mucosal melanoma has be...
4 CitationsSource
#1Mario Sénéchal (Laval University)H-Index: 22
#2Pierre-Louis Bernard (Laval University)H-Index: 1
Last. Michelle Dubois (Laval University)H-Index: 9
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Hypereosinophilic syndromes (HESs) are a group of disorders characterized by end-organ damage caused by eosinophilic infiltration. We present a patient with idiopathic HES with severe tricuspid and mitral regurgitation secondary to Loeffler's endocarditis. In addition to prednisone, imatinib therapy initially helped control the eosinophil count. However, successful long-term remission was achieved with hydroxyurea therapy.
4 CitationsSource
Loeffler's endocarditis is a clinical condition characterized by combination of three key findings: unexplained prolonged and marked eosinophilia (>1500 eosinophils/mm(3) ), absence of a primary cause of hypereosinophilia, and evidence of eosinophil-mediated organ damage. We report a case of a 55-year-old African American male with symptoms of heart failure. Hematology showed white blood cell count of 17 670/mm(3) with 63% eosinophils and an absolute eosinophil count of 11 133/mm(3) . Echocardio...
4 CitationsSource
Hypereosinophilic syndrome (HES) is a rare disorder with unknown global prevalence, barely reported in Hispanic population, and characterized by persistent eosinophilia in association with organ dysfunctions directly attributable to eosinophilic infiltration. Cardiac involvement may be present in 50 to 60% of the patients. This is known as Loffler endocarditis. We present a case of a 36-year-old Hispanic man with signs of heart failure. Laboratory studies showed eosinophilia (23,100/μL). Thoraci...
2 CitationsSource
#1Rekha Mankad (Mayo Clinic)H-Index: 8
#2Crystal R. Bonnichsen (Mayo Clinic)H-Index: 12
Last. Sunil Mankad (Mayo Clinic)H-Index: 33
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Hypereosinophilic syndrome (HES) is a heterogeneous group of conditions that is defined at its core by hypereosinophilia (HE) (blood eosinophil count of >1.5×10 9 /L) and organ damage directly attributable to the HE. Cardiac dysfunction occurs frequently in all forms of HES and is a major cause of morbidity and mortality. Once a significantly elevated eosinophil count is identified, it must be confirmed on repeat testing and the aetiology for the HE must be rigorously sought out with a focus on ...
31 CitationsSource
Cited By0
#1Armstrong C (Heidelberg University)
#2Tim Christian Kuhn (Heidelberg University)
Last. A. Heininger (University Hospital Heidelberg)H-Index: 3
view all 10 authors...
AIMS Upon suspicion of infective endocarditis, the causative microorganism must be identified to optimize treatment. Blood cultures and culturing of removed valves are the mainstay of this diagnosis and should be complemented by growth-independent methods. We assessed the diagnostic benefit of examining removed endocarditis valves by broad-range bacterial PCR to detect causative bacteria in cases where culturing was not available, negative, or inconclusive because a skin commensal was detected, ...
#1Alexander LautenH-Index: 19
#2Marc Martinovic (Charité)
Last. Annette Moter (Charité)H-Index: 29
view all 8 authors...
OBJECTIVE: In spite of the progress in antimicrobial and surgical therapy, infective endocarditis (IE) is still associated with a high morbidity and mortality. IE is characterized by bacterial biofilms of the endocardium, especially of the aortic and mitral valve leading to their destruction. About one quarter of patients with formal surgery indication cannot undergo surgery. This group of patients needs further options of therapy, but due to a lack of models for IE prospects of research are low...