title: The significance of early screening with echocardiography in eosinophilic granulomatosis with polyangiitis.
abstract: Löffler endocarditis is a serious complication of idiopathic hypereosinophilic syndrome characterized by a peculiar type of fibrosing endocarditis. It results in heart failure due to restrictive cardiomyopathy and systemic embolism due to intracardiac thrombus. Here we present a case of a 57-year-old man with Löffler endocarditis concomitant with eosinophilic granulomatosis with polyangiitis. A thrombus in the left ventricular apex was noted on transthoracic echocardiography performed as a screening of left ventricular dilatation, which seemed to be a typical finding of Löffler endocarditis. But there were no findings that indicated restrictive cardiomyopathy. He was diagnosed with Löffler endocarditis at the thrombotic stage and was given methylprednisolone. The thrombus got markedly smaller within 1 month after initiation of the medical treatment. He has been doing well for more than 2 years since then without eosinophilia or left ventricular thrombosis. In the present case, we could successfully detect the thrombus in the left ventricular apex with echocardiography before the occurrence of embolism and provide early medical treatment. Early detection and initiation of medical treatment are extremely important to treat this unusual but often life-threatening condition because methylprednisolone is effective in the necrotic stage and thrombotic stage.
authors.affiliation: Department of Cardiology, Hino Municipal Hospital, 4-3-1, Tamadaira, Hino, Tokyo, 191-0062, Japan. tsugu917@gmail.com.|Department of Cardiology, Sakakibara Heart Institute, Fuchu, Japan. tsugu917@gmail.com.
authors.forename: Toshimitsu
authors.initials: T
authors.lastname: Tsugu
authors.affiliation: Department of Cardiology, Sakakibara Heart Institute, Fuchu, Japan.
authors.forename: Yuji
authors.initials: Y
authors.lastname: Nagatomo
authors.affiliation: Department of Radiology, School of Medicine, Keio University, Tokyo, Japan.
authors.forename: Yoshitake
authors.initials: Y
authors.lastname: Yamada
authors.affiliation: Department of Cardiology, Sakakibara Heart Institute, Fuchu, Japan.
authors.forename: Keitaro
authors.initials: K
authors.lastname: Mahara
authors.affiliation: Department of Radiology, Hino Municipal Hospital, Hino, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Miura
authors.affiliation: Department of Laboratory Medicine, School of Medicine, Keio University, Tokyo, Japan.
authors.forename: Mitsushige
authors.initials: M
authors.lastname: Murata
mesh_terms: D001706:Biopsy; D015267:Churg-Strauss Syndrome / Q000150:complications / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000473:pathology; D042241:Early Diagnosis; D004452:Echocardiography; D014890:Granulomatosis with Polyangiitis / Q000150:complications / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000473:pathology; D006801:Humans; D017681:Hypereosinophilic Syndrome / Q000150:complications / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000473:pathology; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D012867:Skin / Q000473:pathology; D014057:Tomography, X-Ray Computed
keywords: Cardiac thrombus; Churg-Strauss Syndrome; Echocardiography; Hypereosinophilic Syndrome