title: Restrictive myocardium with an unusual pattern of apical hypertrophic cardiomyopathy.
abstract: Loeffler endocarditis is a fibrous restrictive cardiomyopathy thought to be caused by persistent eosinophilia. It is difficult to diagnose, and the prognosis is often poor if the underlying eosinophilia is not promptly recognized and treated. We describe the case of a middle-aged woman treated for hypertrophic cardiomyopathy first detected during a routine check-up at age 35years but whose symptoms gradually progressed over the next 14years. Right ventricular biopsy showed extensive fibrosis of the endocardial tissue, and right heart catheterization revealed right heart failure and a low cardiac output state. Ultimately, she became reliant on inotropic and mechanical cardiovascular support, but we were not able to bridge her to transplant. Autopsy findings were typical of endocardial fibroelastosis, but she had not suffered from any tropical disease or traveled to high-risk areas. The presence of abnormal capillary proliferation suggested a diagnosis of Loeffler endocarditis. Nonetheless, apart from a 6-month period of eosinophilia 7years before her death, a history of well-controlled asthma and several drug sensitivities, we were unable to definitively identify the disease trigger. It is critical to diagnose and treat the underlying eosinophilia of Loeffler endocarditis to avoid a poor prognosis. This case highlights the importance of considering the diagnosis of eosinophilic endomyocarditis in patients with an unusual pattern of apical hypertrophic cardiomyopathy (or myocardial fibrosis of unknown etiology), even when there is no apparent history of eosinophilia.
authors: Department of Transplantation, National Cerebral and Cardiovascular Center, Osaka 565-0873, Japan. Electronic address: takuma7180@gmail.com.
authors: Takuma
authors: T
authors: Sato
authors: Department of Pathology, National Cerebral and Cardiovascular Center, Osaka 565-0873, Japan.
authors: Taka-Aki
authors: TA
authors: Matsuyama
authors: Department of Transplantation, National Cerebral and Cardiovascular Center, Osaka 565-0873, Japan.
authors: Osamu
authors: O
authors: Seguchi
authors: Department of Transplantation, National Cerebral and Cardiovascular Center, Osaka 565-0873, Japan.
authors: Yoshihiro
authors: Y
authors: Murata
authors: Department of Transplantation, National Cerebral and Cardiovascular Center, Osaka 565-0873, Japan.
authors: Haruki
authors: H
authors: Sunami
authors: Department of Transplantation, National Cerebral and Cardiovascular Center, Osaka 565-0873, Japan.
authors: Masanobu
authors: M
authors: Yanase
authors: Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Osaka 565-0873, Japan.
authors: Tomoyuki
authors: T
authors: Fujita
authors: Department of Pathology, National Cerebral and Cardiovascular Center, Osaka 565-0873, Japan.
authors: Hatsue
authors: H
authors: Ishibashi-Ueda
authors: Department of Transplantation, National Cerebral and Cardiovascular Center, Osaka 565-0873, Japan.
authors: Takeshi
authors: T
authors: Nakatani
mesh_terms: D001344:Autopsy; D001706:Biopsy; D002312:Cardiomyopathy, Hypertrophic / Q000209:etiology / Q000473:pathology* / Q000503:physiopathology / Q000628:therapy; D002423:Cause of Death; D004452:Echocardiography; D017809:Fatal Outcome; D005260:Female; D005355:Fibrosis; D006801:Humans; D017681:Hypereosinophilic Syndrome / Q000150:complications / Q000473:pathology* / Q000503:physiopathology / Q000628:therapy; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D009206:Myocardium / Q000473:pathology*; D018487:Ventricular Dysfunction, Left / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D018497:Ventricular Dysfunction, Right / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D016277:Ventricular Function, Left; D016278:Ventricular Function, Right
keywords: Cardiomyopathy; Eosinophilia; Heart failure; Hypereosinophilic syndrome; Hypertrophic; Restrictive