Loeffler endocarditis in a young patient with biventricular involvement. A case report
https://doi.org/10.15829/1560-4071-2025-6389
EDN: HSPJQG
Abstract
Introduction. Loeffler endocarditis (LE) is a rare restrictive cardiomyopathy characterized by endocardial and myocardial eosinophil infiltration followed by degranulation, intracardiac thrombus formation, and fibrosis. Fibrosis leads to progressive heart failure (HF), requiring heart transplantation in the end stage.
Brief description. A case report of a 20-year-old female patient with LE is presented. The patient presented chest pain, dyspnea, weakness, low-grade fever, and severe eosinophilia (eosinophil count up to 50%, white blood cell count up to 48×109/l). Diagnostic search for eosinophilia causes (eosinophilic leukemia, hematological malignancies, parasitic infections, systemic diseases) did not yield any results. Against the background of progressive heart failure and a decrease in the left ventricular ejection fraction to 35%, the patient was transferred to a federal center. Conservative therapy compensated heart failure, and there were no indications for heart transplantation. Over the next year, there were rehospitalizations to federal centers. Weakness, shortness of breath, grade III mitral regurgitation and eosinophilia persisted.
The absence of a permanent attending physician and supervising medical facility made follow-up difficult.
Discussion. It seems beneficial to create a registry of LE patients, route patients to specialized centers and manage outpatient follow-up by a multidisciplinary team. This case emphasizes the importance of early diagnosis and timely treatment of LE to improve the prognosis, as well as the need to increase physician awareness of this pathology.
About the Authors
G. M. Khairutdinova
Emergency Hospital
Russian Federation
Competing Interests:
Russian Federation
Naberezhnye Chelny
Competing Interests:
none
L. A. Shakirzyanova
Emergency Hospital
Russian Federation
Competing Interests:
Russian Federation
Naberezhnye Chelny
Competing Interests:
none
References
1. Mubarik A., Iqbal A.M. Loeffler endocarditis // StatPearls [Internet]. – 2020 Jan. – Доступно на: [QxMD MEDLINE Link].
2. Wang S.A., Orazi A., Gotlib J., et al. The international consensus classification of eosinophilic disorders and systemic mastocytosis // Am J Hematol. – 2023. – Vol. 98, №8. – P. 1286–1306. – DOI: 10.1002/ajh.26966.
3. Weller P.F., Bubley G.J. The idiopathic hypereosinophilic syndrome // Blood. – 1994. – Vol. 83, №10. – P. 2759–2779. – PMID: [QxMD MEDLINE Link].
4. Richardson S.G., et al. Cardiac involvement in the hypereosinophilic syndrome: prospective evaluation with echocardiography // Blood. – 1982. – Vol. 60, №3. – P. 619–625.
5. Gotlib J. World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management // Am J Hematol. – 2015. – Vol. 90, №11. – P. 1077–1089.
6. Alderman E.L. Non-infective endocardial disease // Cardiovascular Disease. – 1999. – P. 1–7.
7. Polito M.V., Hagendorff A., Citro R., Prota C., Silverio A., De Angelis E., Klingel K., Metze M., Stöbe S., Hoffmann K.T., Sabri O., Piscione F., Galasso G. Loeffler's Endocarditis: An Integrated Multimodality Approach // J Am Soc Echocardiogr. – 2020. – Vol. 33, №12. – P. 1427–1441. – DOI: 10.1016/j.echo.2020.09.002.
8. Mankad R., Bonnichsen C., Mankad S. Hypereosinophilic syndrome: cardiac diagnosis and management // J Am Coll Cardiol. – 2016. – Vol. 67, №9. – P. 113–122.
9. Roufosse F.E., et al. Hypereosinophilic syndromes: clinical features, pathophysiology, and treatment // Immunol Allergy Clin North Am. – 2015. – Vol. 35, №3. – P. 387–403.
10. Ogbogu P.U., Bochner B.S., Butterfield J.H., et al. Hypereosinophilic syndrome: a multicenter, retrospective analysis of clinical characteristics and response to therapy // J Allergy Clin Immunol. – 2009. – Vol. 124, №6. – P. 1319–1325.
11. Curtis C., Ogbogu P. Hypereosinophilic syndrome // Clin Rev Allergy Immunol. – 2016. – Vol. 50, №2. – P. 240–251.
12. Rothenberg M.E., Klion A.D., Roufosse F.E., et al. Treatment of hypereosinophilic syndrome with mepolizumab // N Engl J Med. – 2008. – Vol. 358, №12. – P. 1215–1228.
13. Gleich G.J., Leiferman K.M., Pardanani A., et al. Treatment of hypereosinophilic syndrome with monoclonal anti–interleukin-5 antibody // N Engl J Med. – 2002. – Vol. 347, №4. – P. 269–270.
14. Weller P.F., Bubley G.J. The idiopathic hypereosinophilic syndrome // Blood. – 1994. – Vol. 83, №10. – P. 2759–2779.
15. Reiter A., Gotlib J. Myeloid neoplasms with eosinophilia // Blood. – 2017. – Vol. 129, №6. – P. 704–714.
Supplementary files
- A case of Loeffler endomyocarditis with biventricular involvement against the background of hypereosinophilic syndrome in a 20-year-old patient without obvious etiologic factors is presented.
- A diagnostic feature was the accidental detection of ventricular thrombosis during a pleural ultrasound performed on the 8thday after the primary echocardiography.
- The need to create a registry of patients with LE, route patients to specialized centers and manage follow-up monitoring by a multidisciplinary team is noted.
- The purpose of the presented case report is to increase physicians’ awareness of this rare pathology, since timely diagnosis and early initiation of therapy determine the long-term prognosis of patients with LE.
Review
For citations:
Khairutdinova G.M., Shakirzyanova L.A. Loeffler endocarditis in a young patient with biventricular involvement. A case report. Russian Journal of Cardiology. 2025;30(10S):6389. (In Russ.) https://doi.org/10.15829/1560-4071-2025-6389. EDN: HSPJQG
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