Abayazeed Rasha Mohamed, Abdel-Hay Mohamed Ayman, Elfwal Sara, Hssanein Mahmoud
Department of Cardiology, Faculty of Medicine, Alexandria University, Alexandria, Egypt.
Eur Heart J Case Rep. 2018 Mar 13;2(2):yty030. doi: 10.1093/ehjcr/yty030. eCollection 2018 Jun.
Hypereosinophilic syndrome (HES) is a myeloproliferative disorder characterized by persistent eosinophilia that is associated with damage to multiple organs.
Herein, we describe a case of left ventricular (LV) Löffler endocarditis on top of idiopathic HES leading to inflow and outflow obstruction. The posterior mitral leaflet was involved in the fibrotic process leading to severe mitral valve regurgitation. There was a mural thrombus in the left ventricle, which resulted in thrombo-embolic complications in the form of lower limb ischaemia. The patient was treated with high-dose corticosteroids and anticoagulants with significant improvement of his cardiac condition.
In patients with persistent hypereosinophilia, thorough workup is recommended to identify any possible primary cause and detect associated end-organ damage. Treatment should be started as early as possible after establishing the diagnosis to reduce morbidity and prevent complications. Corticosteroids are the first-line therapy that usually cause a rapid reduction in the level of the eosinophilia and must be started promptly if cardiac involvement is present to attain rapid reduction in the eosinophil level and reverse the cardiac damage.
高嗜酸性粒细胞综合征（HES）是一种骨髓增殖性疾病，其特征为持续性嗜酸性粒细胞增多，并伴有多器官损害。
在此，我们描述一例特发性HES基础上发生的左心室（LV）Löffler心内膜炎，导致流入道和流出道梗阻。二尖瓣后叶参与纤维化过程，导致严重二尖瓣反流。左心室有附壁血栓，导致下肢缺血形式的血栓栓塞并发症。该患者接受了大剂量皮质类固醇和抗凝剂治疗，心脏状况有显著改善。
对于持续性嗜酸性粒细胞增多的患者，建议进行全面检查以确定任何可能的原发性病因并检测相关的终末器官损害。确诊后应尽早开始治疗，以降低发病率并预防并发症。皮质类固醇是一线治疗药物，通常会使嗜酸性粒细胞水平迅速降低，如果存在心脏受累，必须立即开始使用，以迅速降低嗜酸性粒细胞水平并逆转心脏损害。
