Loeffler Endocarditis as a Manifestation of Paraneoplastic Hypereosinophilia
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ABSTRACT:
SUBMITTER: Kelley B
PROVIDER: S-EPMC7581568 | biostudies-literature | 2020 Jun
REPOSITORIES: biostudies-literature
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Project description:Highlights•Loeffler endocarditis is a systemic manifestation of HE.•Laboratory studies include CBC and cytogenetics for the FIP1L1-PDGFRA fusion gene.•Imaging studies include echocardiography, cardiac catheterization, and CMR.•The cornerstone of treatment includes steroids and anticoagulation.•Medications, such as antipsychotics, can cause secondary HE.
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Project description:Idiopathic hypereosinophilic syndrome is an uncommon leukoproliferative systemic disorder characterized by the overproduction of eosinophils and poor prognosis. A major source of morbidity and mortality of this syndrome is the associated cardiac involvement represented by endocardial thickening and mural thrombi. We report a 64-year-old woman with persistent symptoms of heart failure despite standard medical therapy. Echocardiography revealed reduced left ventricular filling due to a large apical mass; an abnormal diastolic filling pattern was also noticed. Complete blood count revealed remarkable hypereosinophilia. Cardiac magnetic resonance imaging demonstrated an apical thrombus and intense linear enhancement of the endocardium, which were compatible with Löffler endocarditis. Medical therapy, including corticosteroids and anticoagulation, was initiated promptly. The symptoms improved as the peripheral hypereosinophilia resolved in 15 days. The patient was asymptomatic at the 1-year follow-up visit with complete regression of the apical thrombus and no evidence of restrictive cardiomyopathy. We report this case to draw attention to this particularly rare condition with poor prognosis since quick and accurate diagnosis and prompt initiation of therapy may improve symptoms and survival.
| S-EPMC2533383 | biostudies-other
Project description:Here we describe a case of infective endocarditis caused by Tropheryma whipplei in a patient with no other symptoms of Whipple's disease. The case was diagnosed using broad-range PCR and confirmed by specific PCRs. We review the cases of infective endocarditis presenting as the only manifestation of Whipple's disease reported in the literature.
| S-EPMC1933109 | biostudies-literature
Project description:We describe the case of a 43-year-old woman with transient ischemic neurologic deficits and recurrent systemic and pulmonary emboli in whom infectious work-up and extensive thrombophilic evaluation were unremarkable. Transesophageal echocardiography (TEE) established the diagnosis of nonbacterial thrombotic endocarditis (NBTE). This is a rare condition often associated with hypercoagulable states or advanced malignancy such as adenocarcinomas, characterized by cardiac vegetations along valvular coaptation lines without destruction of leaflets. In our patient, we diagnosed an ovarian clear cell adenocarcinoma, a malignant disorder that has been rarely reported in association with NBTE. This case illustrates that NBTE can present as an atypical manifestation of malignancy and must be distinguished from infective endocarditis, which implies a different therapeutic strategy. When confronted with findings of NBTE without a clear etiology, an occult neoplasm must be excluded. Anticoagulant therapy is the mainstay of treatment. However, cardiac vegetations may require surgical intervention in rare instances.
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Project description:We describe a case presenting complaint of complete lower body paraparesis, which was discovered to have splenic marginal zone lymphoma (SMZL). While paraneoplastic syndromes are more common in tumors, such as small cell lung cancer, very few reports exist on this condition with SMZL. We describe such a rare entity with a clinical course spanning twenty-four months after diagnosis.
| S-EPMC4879228 | biostudies-literature
Project description:Introduction. Infective endocarditis in the left heart may be complicated by stroke, due to embolisation from infectious valvular vegetations. Infarction of both occipital lobes, which are supplied by the posterior cerebral arteries, is infrequent, and is the cause of cortical blindness from lesion of the visual cortex. Cortical blindness is characterized by intact pupillary reflexes, a normal fundoscopy, and, rarely, denial of visual loss. Case Presentation. We report the case of a 58-year-old woman, recipient of a mechanical aortic valve, who presented with fever, multiple organ dysfunction, and cortical blindness. Transesophageal echocardiography and blood cultures confirmed the diagnosis of infective endocarditis caused by methicillin-sensitive Staphylococcus aureus. Computed tomography of the brain without contrast revealed the presence of infarctions in both occipital lobes. It is noteworthy that the visual loss resolved after treatment of endocarditis. Conclusions. A stroke occurring in a patient presenting with fever and a history of valvular heart disease strongly suggests the presence of infective endocarditis. Bilateral thromboembolic infarcts of the occipital lobes cause cortical blindness, that can resolve after treatment of endocarditis.
| S-EPMC2929621 | biostudies-literature
Project description:Cardiac involvement in hypereosinophilia is rare; when present, it manifests as ventricular thickening, usually with fibrous tissue and mural thrombosis. We present a case of a 57-year-old man with an abnormal right ventricular apex with eosinophilia, which was caused by Toxocara canis infection.
| S-EPMC4286646 | biostudies-literature
Project description:BackgroundEosinophilia is associated with various conditions, including allergic, infectious, and neoplastic disorders. The diagnostic differential is broad, and data on hypereosinophilia in pediatric patients are limited.ObjectiveThe objectives of this study were to identify cases of hypereosinophilia in a tertiary pediatric medical center, determine clinical characteristics and disease associations, and estimate the incidence of hypereosinophilia in the hospital and geographic populations.MethodsA retrospective chart review included patients younger than 18 years presenting to a tertiary pediatric medical center (January 1, 2008, to May 31, 2017) with absolute eosinophil counts (AECs) greater than or equal to 1.50 thousand eosinophils/microliter (K/μL) recorded on at least 2 occasions at least 4 weeks apart (N = 176). Clinical characteristics, laboratory values, treatment course, and associated diagnoses were evaluated.ResultsThe most common cause of hypereosinophilia in this cohort was secondary hypereosinophilia. Atopic dermatitis, graft-versus-host disease, sickle cell disease, and parasitic infections were the most common conditions associated with hypereosinophilia. Median age at diagnosis was 4.6 (interquartile range, 1.5-10.5) years. Median peak AEC was 3.16 (2.46-4.78) K/μL. Hypereosinophilia occurred most frequently in patients aged between 6 and 11 years (24.4%) and younger than 1 year (18.2%). Patients with neoplasms and immune deficiencies had significantly higher peak AECs than did patients with overlap hypereosinophilic syndrome and atopic diseases (P < .0001).ConclusionsPediatric hypereosinophilia has an incidence of 54.4 per 100,000 persons per year, with children younger than 1 year and aged 6 to 11 years accounting for most affected patients. Pediatric hypereosinophilia is not uncommon and remains underrecognized, highlighting a need for clinicians to identify patients who meet criteria for hypereosinophilia and to pursue a thorough evaluation.
| S-EPMC6842676 | biostudies-literature
Project description:BACKGROUND:The differential diagnosis of hypereosinophilia is broad and includes asthma, atopic disease, drug hypersensitivity, parasitic infection, connective tissue disorders, malignancy, and rare hypereosinophilic disorders. Hypereosinophilia in children has not been well characterized to date. OBJECTIVE:The objective of this study was to identify the common causes of marked eosinophilia in children and to characterize and compare the clinical symptoms at presentation, laboratory findings, final diagnosis, and therapeutic responses between children and adults with hypereosinophilic syndromes. METHODS:A retrospective analysis of consecutive subjects evaluated for unexplained eosinophilia ? 1.5 × 10(9)/L was conducted. All subjects underwent standardized clinical and laboratory evaluations with yearly follow-up. Clinical and laboratory parameters, final diagnoses, treatment responses, and outcomes were assessed. Medians and proportions were compared using Mann-Whitney U and Fisher Exact tests, respectively. RESULTS:Of the 291 subjects evaluated, 37 (13%) were children and 254 were adults (87%). Whereas the frequencies of clinical hypereosinophilic syndrome (HES) variants were similar between children and adults, primary immunodeficiency was a more common secondary cause of HES in children (5% vs 0.4% in adults). Excluding subjects with treatable secondary causes, the median peak absolute eosinophil count was increased in pediatric subjects (9376 vs 5543/?L; P = .002), and children had more gastrointestinal complaints (62% vs 34%; P = .003) and less pulmonary involvement (34% vs 59%; P = .01) than adults. Despite these differences, corticosteroid responsiveness and overall prognosis were similar between the 2 groups. CONCLUSIONS:Although children with HES often present with higher peak eosinophil counts than adults, the differential diagnosis, clinical characteristics, and prognosis of HES are similar in the 2 groups.
| S-EPMC5010485 | biostudies-literature