Idiopathic Hypereosinophilic Syndrome Presenting With Acute Heart Failure and Mesenteric Thromboembolism: Review of the Literature*
Abstract
Acute heart failure due to cardiac involvement of idiopathic hypereosinophilic syndrome has poor prognosis and high mortality rate. We present a 52 year old male patient with hypereosinophilic syndrome resulting in acute heart failure and mesenteric thromboembolism. Non ST elevation myocardial infarction (high troponin
levels) was considered in the differential diagnosis of acute heart failure. However acute coronary syndrome was excluded with diagnostic coronary angiography. The laboratory results showed hypereosinophilia on the blood count. Cardiac magnetic resonance imaging (CMR) showed diffuse left ventricular dilatation, wallmotion abnormalities and left ventricular apical thrombus without subendocardial fibrosis. He was treated according to heart failure guidelines and the patient status improved clinically. With the corticosteroid treatment, eosinophil count, C-reactive protein levels returned to normal range. Nevertheless, his clinical condition deteriorated due to massive mesenteric thromboembolism and died after cardiogenic shock and sepsis. In the pathogenesis of the disease, eosinophil derived granüls may be responsible for the cardiac damage and clinical variability that was ranging from cardiogenic shock to endomyocardial fibrosis. Early diagnosis and treatment can prevent morbidity and mortality.
Keywords
Hypereosinophilic syndrome, eosinophilia, heart failure, thromboembolism
References
- 1. Simon HU, Rothenberg ME, Bochner BS et al. Refining the definition of hypereosinophilic syndrome. J Allergy Clin Immunol. 2010;126:45-49.
- 2. Mankad R, Bonnichsen C, Mankad S. Hypereosinophilic syndrome: cardiac diagnosis and management. Heart 2016;102(2):100-6.
- 3. Ommen SR, Seward JB, Tajik AJ. Clinical and echocardiographic features of hypereosinophilic syndromes. Am J Cardiol 2000;86(1):110-3.
- 4. Kleinfeldt T, Nienaber CA, Kische S et al. Cardiac manifestation of the hypereosinophilic syndrome: newinsights. Clin Res Cardiol 2010;99(7):419-27.
- 5. Gotlib J. World Health Organization-defined eosinophilic disorders: 2014 update on diagnosis, risk stratification, and management. Am J Hematol 2014 Mar. 89(3):325-37.
- 6. Chusid MJ, Dale DC, West BC et al. The hypereosinophilic syndrome: analysis of fourteen cases with review of the literature. Medicine (Baltimore). 1975;54(1): 1-27.
- 7. Weller PF, Bubley GJ. The idiopathic hypereosinophilic syndrome. Blood. 1994;83(10):2759-79.
- 8. Cincin AA, Ozben B, Tanrikulu MA et al. Large apical thrombus in a patient with persistent heart failure and hypereosinophilia: Löffler endocarditis. J Gen Intern Med 2008; 23:1713-8.
- 9. Fuzellier JF, Chapoutot L, Torossian PF et al. Mitral valve replacement in idiopathic eosinophilic endocarditis without peripheral eosinophilia. J Card Surg 2005; 20(5):472-4.
- 10. Ogbogu PU, Rosing DR, Horne MK. Cardiovascular manifestations of hypereosinophilic syndromes. Immunol Allergy Clin North Am 2007;27(3):457-75.