Unexpected eosinophilic myocarditis in a young woman with rapidly progressive dilated cardiomyopathy

MRI as an Effective Tool for the Diagnosis and Monitoring of Leffler Endocarditis at the Stages of Longitudinal Observation

Hypereosinophilic syndrome (HES) is an extremely rare disease that is not always diagnosed, and the lack of statistic data does not let to determine its real incidence. Among patients men predominate, the ratio of men and women is 9: 1, the most vulnerable age is from 20 to 50 years. The familial hypereosinophilia is inherited disease of autosomal dominant type. Two-year mortality was recorded in half of the cases of Leffler’s endocarditis with progressive fibrosis due to heart failure and thromboembolic complications. Leffler’s endocarditis and endomyocardial fibrosis as components of restrictive cardiomyopathy are accompanied by eosinophilia. The story of the discovery of eosinophils is closely connected to the name of Paul Ehrlich; the further idea of tracing the connection between eosinophilia and the involvement of the heart and other organs belongs to Leffler. In the presence of Leffler’s syndrome, the probability of thrombosis in the heart cavities and determination of the stage of the disease were analyzed by longitudinal observation using cardiac MRI. The described clinical case of Leffler syndrome in a young man in real clinical practice clearly demonstrates the difficulties of diagnosis in the outpatient phase, need in interdisciplinary approach in the work of the team “heart team” during the hospital period, the role and importance of long-term cardiac MRI monitoring of the selected optimal therapy. Leffler’s syndrome in real clinical practice requires from physicians of various specialties, including family physicians, knowledge of etiology, pathogenesis, clinical masks of disease manifestation and tactics of patient management in the outpatient phase. MRI of the heart remains the “gold standard” for diagnosis and longitudinal monitoring of patients with Leffler syndrome.

Eosinophilic myocarditis in an adolescent: a case report and review of the literature

Eosinophilic myocarditis is a rare disease occurring mainly in adulthood. It is generally known to be caused by autoimmune diseases, parasitic infections, hypersensitivity to drugs or substances, and after vaccinations. We describe the case of a 15-year-old adolescent, who presented initially with flu-like symptoms, as well as syncope. Subsequently, catecholaminergic treatment had to be initialised because of cardiac failure. Peripheral eosinophil count was normal at admission and at the time of endomyocardial biopsy. The biopsy, however, proved the diagnosis of eosinophilic myocarditis, but the causative agent remained unclear despite intensive diagnostic work-up. Cardiac magnetic resonance imaging showed signs of acute myocardial oedema and a delayed enhancement in the basal inferolateral segments consistent with acute myocarditis. Under treatment with corticosteroids, angiotensin-converting enzyme inhibitor, and warfarin, we accomplished a rapid and complete recovery of cardiac function and histology. This unique case of eosinophilic myocarditis is rare in childhood. The differential diagnosis and diagnostic pathway is discussed, and a review of the literature and therapeutic options based on the literature is performed.

Heart failure mimicking prior myocardial infarction in a patient with idiopathic hypereosinophilic syndrome

Idiopathic hypereosinophilic syndrome (IHES) is characterized by sustained, nonreactive hypereosinophilia with eosinophilia-associated organ damage. Cardiac involvement occurs in about 60% of patients with HES and it is the major cause of mortality in these patients. Cardiac dysfunction is reversible only after early corticosteroid (CS) initiation.Herein we report a 33-year old male who was referred to our Cardiology Department with electrocardiographic and echocardiographic abnormalities suggesting myocardial infarction. At presentation he complained of dyspnea, cough and persistent fever. His white blood cell (WBC) count was elevated, with eosinophil predominance in the differential. After cardiological and haematological work-up, the final diagnosis of HES-associated cardiac involvement was established. Early treatment with CS led to eosinophil count normalization with only moderate cardiac function improvement. Currently, the patient is in good condition overall and is in NYHA class II while still on prednisone.

[Heart and freezer: about one case of hypereosinophilia and coronary spasm]

We report the case of a 41-year-old woman, non-smoker, without cardiovascular risk, hospitalised for acute ST elevation myocardial infarction. The coronarography showed no significant coronary stenosis and a methylergometrine test performed was positive. After the discovery of a moderate chronic hypereosinophilia, a review of the literature about eosinophile and coronary pathology was realised in order to make a link between hypereosinophilia and coronary spasm.