Löffler endocarditis: a rare cause of acute cardiac failure

Abstract

We describe a patient with acute cardiogenic shock due to cardiac involvement in idiopathic hypereosinophilic syndrome (Löffler endocarditis). At the echocardiography, there was a huge mass in the left ventricular cavity, resulting in inflow- and outflow tract obstruction. The posterior leaflet of the mitral valve apparatus was completely embedded in a big (organized) thrombus mass. The patient was treated with high dose corticosteroids, however without effect. Partial remission was achieved after treatment with hydroxycarbamide. He was also treated with anticoagulants and high dose beta-blockers. The patient's condition improved remarkably after correction of the mitral valve insufficiency by a mitral valve bioprosthesis.

Figure 1

Electrocardiogram at admission showing a sinusrythm with ST-elevations in V1-V3 and ST-depressions in II, III, AVF, V5 and V6.

Figure 2

A and B, Echocardiographic parasternal long axis view and four-chamber view at presentation, showing big thrombotic mass with the base at the posterior wall and infiltration of the left ventricular wall.

Figure 3

A and B, Same view at 4 months of follow-up, demonstrating smaller but evidently present thrombotic mass, with embedded posterior leaflet apparatus of the mitral valve, resulting in severe mitral regurgitation (not shown).