Cui Yue, Shi Yugen, Wang Xiaojun
Department of Cardiology, The First Affiliated Hospital of Shandong First Medical University, Shandong First Medical University, Shandong, China.
Front Cardiovasc Med. 2024 Dec 13;11:1456788. doi: 10.3389/fcvm.2024.1456788. eCollection 2024.
It is unusual for young patients without any underlying diseases to experience sudden cerebral infarction and heart failure. Here, we report a rare case of a 28-year-old female patient who presented with chest tightness and dizziness. Left ventricular thrombus formation and cardiac insufficiency were evident on echocardiogram, while multiple acute or subacute cerebral infarctions were visible on brain magnetic resonance imaging. We preliminarily determined that this was a different manifestation of the same disease. After investigating the cause, we diagnosed the patient with Loeffler endocarditis caused by idiopathic eosinophilia syndrome involving the heart. Although no endocardial biopsy was performed, this diagnosis was confirmed through cardiac magnetic resonance imaging (CMR). After drug treatment consisting of corticosteroids and anticoagulants, the eosinophil count decreased significantly; however, the thrombus did not completely disappear, as assessed in multiple follow-up echocardiogram sessions. Further exploration of the tissue composition of the patient's left ventricular mass suggested that the mass was a mixture of thrombus and eosinophilic granulation tissue. The addition of imatinib to the treatment plan had a good therapeutic effect, and the patient's left ventricular mass completely disappeared. Loeffler endocarditis progresses rapidly and requires early identification and intervention by clinicians. This case emphasizes that, despite the lack of an endocardial biopsy, the early diagnosis of Loeffler endocarditis can be made through CMR, while avoiding the occurrence of irreversible endocardial fibrosis. We also explored the nature of the patient's cardiac mass and proposed different insights. The nature of cardiac mass varies in different stages of Loeffler endocarditis, and individualized treatment strategies are needed.
对于没有任何基础疾病的年轻患者而言，出现突发性脑梗死和心力衰竭是不常见的。在此，我们报告一例罕见病例，一名28岁女性患者出现胸闷和头晕症状。超声心动图显示左心室血栓形成和心功能不全，而脑部磁共振成像可见多处急性或亚急性脑梗死。我们初步判定这是同一疾病的不同表现形式。在查明病因后，我们诊断该患者患有由累及心脏的特发性嗜酸性粒细胞增多综合征引起的勒夫勒心内膜炎。尽管未进行心内膜活检，但通过心脏磁共振成像（CMR）证实了这一诊断。在使用皮质类固醇和抗凝剂进行药物治疗后，嗜酸性粒细胞计数显著下降；然而，在多次随访超声心动图检查中评估发现，血栓并未完全消失。对患者左心室肿物的组织成分进一步探查表明，该肿物是血栓和嗜酸性粒细胞肉芽组织的混合物。在治疗方案中加用伊马替尼具有良好的治疗效果，患者的左心室肿物完全消失。勒夫勒心内膜炎进展迅速，临床医生需要早期识别并进行干预。该病例强调，尽管缺乏心内膜活检，但通过CMR可对勒夫勒心内膜炎进行早期诊断，同时避免发生不可逆的心内膜纤维化。我们还探究了患者心脏肿物的性质并提出了不同见解。勒夫勒心内膜炎不同阶段心脏肿物的性质各异，需要个体化的治疗策略。
