Echocardiographic Changes in Eosinophilic Endocarditis Induced by Churg-Strauss Syndrome

Abstract

Eosinophilic myocarditis may be accompanied by Churg-Strauss syndrome (CSS). We report a case of CSS that was accompanied by myocardial changes in the early stage. A 71-year-old woman complained of mild chest pain at rest, but routine echocardiography did not reveal any endocardial abnormalities. Four months later, the patient was hospitalized due to congestive heart failure with neuropathy of both upper extremities. A diagnosis of eosinophilic myocarditis was made based on the patient's laboratory results and the presence of mural thrombus. This case illustrates that, although early eosinophilic myocarditis is an important differential diagnosis in patients with chest pain, it may be difficult to identify in without an apparent mural thrombus.

Figure 1.

Chest roentgenograms and electrocardiograms. A chest roentgenogram (a) from the first admission appeared normal, and an electrocardiogram (b) that was taken at the same time demonstrated nonspecific ST-T changes. However, the chest roentgenogram from the second admission (c) showed pleural effusion and infiltration, which was suggestive of eosinophilic pneumonia and heart failure. An electrocardiogram from the second admission showed almost no changes.

Figure 2.

Routine echocardiography from the patient’s first admission. Parasternal (a) and short-axis (b) views in the early stage of eosinophilic myocarditis show a superficial layer on the endocardium, suggesting a thrombus (arrow).

Figure 3.

Left ventriculography from the patient’s first admission. The diastolic (a) and systolic (b) phases show an abnormal pattern of contrast medium at the apex, with normal systolic function.

Figure 4.

Echocardiography at the time of the diagnosis of Churg-Strauss syndrome and after the initiation of treatment. The echocardiogram from the third day of the second admission (a) demonstrates a mural thrombus (white arrow) occupying the left ventricular cavity. Color Doppler echocardiography (b) shows two blood flows from the endocardium of the lateral wall. On the 20th day during steroid and anticoagulation therapy, the superficial layer of the thrombus was detached from the endocardium (c). On the 91st day, the thrombus had disappeared (d).