[Idiopathic hypereosinophilia with cardiac involvement].
METHODS
A 34-year-old previously healthy woman was admitted to another hospital because of abdominal pain, cough and dyspnea. Peripheral eosinophilia was present. Two months later she was admitted to the cardiology department with signs of mitral regurgitation. Dyspnea, fatigue, skin rashes with pruritus and a systolic murmur were noted.


METHODS
Laboratory tests showed 11.4/nl leukocytes (normal range 4.8-10.8/nl) with an eosinophilia of 19% (normal range < 4%) corresponding to 2.2/nl. Cardiac magnetic resonance imaging revealed endomyocardial fibrosis involving the posterior mitral leaflet with resulting valvular regurgitation. Doppler ultrasound showed restrictive heart failure. DIAGNOSIS, THERAPY AND FURTHER COURSE: The diagnosis of idiopathic hypereosinophilia most likely as part of hypereosinophilic syndrome with cardiac involvement was made. The patient was treated with digitalis, diuretics and peptidyl dipeptidase (PDP) inhibitor. The treatment with glucocorticoids and cytotoxic agent to achieve a reduction of eosinophil count was ended by the patient a few weeks later.


CONCLUSIONS
The hypereosinophilic syndrome with endomyocardial fibrosis is rare, and its prognosis is grave. The pathophysiological mechanisms are not entirely clear, nearly 70 years after Löffler first described fibrous endocarditis with eosinophilia. Patients receive symptomatic medical therapies. Additional surgical treatment has been reported,. Antihypereosinophilic therapy is used to control the disease.
Martin
N
N
Medizinische Klinik I, Klinikum Krefeld.
Ott
R
R
Klues
H G
HG
D000328:Adult; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000008:administration & dosage / Q000627:therapeutic use; D002313:Cardiomyopathy, Restrictive / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology; D002316:Cardiotonic Agents / Q000008:administration & dosage / Q000627:therapeutic use; D003937:Diagnosis, Differential; D004077:Digoxin / Q000008:administration & dosage / Q000627:therapeutic use; D004232:Diuretics / Q000008:administration & dosage / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D015150:Echocardiography, Doppler; D004656:Enalapril / Q000008:administration & dosage / Q000627:therapeutic use; D004719:Endomyocardial Fibrosis / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy / Q000628:therapy; D005260:Female; D006801:Humans; D017681:Hypereosinophilic Syndrome / Q000175:diagnosis / Q000188:drug therapy / Q000628:therapy; D008279:Magnetic Resonance Imaging; D000451:Mineralocorticoid Receptor Antagonists / Q000008:administration & dosage / Q000627:therapeutic use; D008944:Mitral Valve Insufficiency / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology; D010349:Patient Compliance; D011379:Prognosis; D013148:Spironolactone / Q000008:administration & dosage / Q000627:therapeutic use; D013449:Sulfonamides / Q000008:administration & dosage / Q000627:therapeutic use; D000077786:Torsemide
D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents; D002316:Cardiotonic Agents; D004232:Diuretics; D000451:Mineralocorticoid Receptor Antagonists; D013449:Sulfonamides; D013148:Spironolactone; D004656:Enalapril; D004077:Digoxin; D000077786:Torsemide