Severe mitral regurgitation caused by eosinophilic endocarditis

Abstract

We describe a patient with symptoms of heart failure caused by severe mitral regurgitation. Echocardiography revealed an intracardiac mass embedding the posterior mitral valve leaflet, and cardiac magnetic resonance imaging showed two intracardiac thrombi and endomyocardial fibrosis. Eosinophil count kept rising and a mutation in the gene for platelet-derived growth factor receptor alpha was found. The combination of these findings led to the diagnosis of Loeffler's endocarditis. Treatment with prednisone and a tyrosine kinase inhibitor resulted in complete remission of the hypereosinophilia and mitral valve regurgitation was only mild at 9-month follow-up visit. <Learning objective: This case report presents a patient with severe mitral regurgitation and heart failure due to hypereosinophilic syndrome (HES). It leads to thrombus formation and endomyocardial thickening due to eosinophilic infiltration of the myocardium. Treatment with steroids and a tyrosine kinase inhibitor led to clinical improvement and only mild mitral regurgitaton after 6 months. Loeffler's endomyocarditis is a model disease for restrictive cardiomyopathy. It is important to recognize and treat this disease early and prevent morbidity and mortality. As far as we know there is no previous case report that describes the reversibility of severe mitral regurgitation after pharmacological treatment of HES, not needing mitral valve replacement.>.

Keywords: Cardiac magnetic resonance imaging; Echocardiography; Eosinophilia; Loeffler's endocarditis.

Fig. 1

Transesophageal echocardiography: severe mitral valve insufficiency detected with color Doppler imaging (left), due to a mass embedding the posterior mitral valve leaflet (right).

Fig. 2

Cardiac magnetic resonance late enhancement image showing left ventricular thrombi in the apex and basal–lateral.