Case report: Application of non-VKA oral anticoagulants in patient of idiopathic hypereosinophilic syndrome with intracardiac thrombus

Abstract

Idiopathic hypereosinophilic syndrome (IHES) is a rare but life-threatening disease related to a group of myeloproliferative disorders characterized by prolonged eosinophilia of unknown cause and inflammatory damage to multiple organs. Here, we present a 44-year-old female patient complaining of shortness of breath and palpitations for 1 month. Her history and presentation were unremarkable, except for a 3-years history of rheumatoid arthritis treated with ibuprofen (0.3 g per day). Initial examination showed heart rate (HR) 120 bpm, respiratory rate (RR) 20 bpm, temperature (T) 36°C, blood pressure (BP) 130/70 mmHg, ventricular gallop rhythm, rales at the lung bases, soft abdomen, nonpalpable liver and spleen, and slight edema in both lower extremities. Bone marrow aspirate and biopsy confirmed the diagnosis of IHES, while cardiac MRI showed intracardiac thrombus. The symptoms of shortness of breath and palpitation disappeared, the eosinophil counts in routine blood tests were normal, and the thrombus in the cardiac cavity gradually disappeared after combined therapy of anti-hypereosinophilic, anti-coagulant and anti-heart failure treatments.

Keywords: case report; heart failure; idiopathic hypereosinophilic syndrome; intracardiac thrombus; non-VKA oral anticoagulants; shortness of breath.

FIGURE 1

ECG at admission, showing flat T wave in I, II, III, AVF, and V1 to V6; ST segment depression in II, III, AVF, and V5; and poor R wave progression in the thoracic leads (V1-V4).

FIGURE 2

Images of cine-cardiac magnetic resonance show the thrombi (long arrows) in the apex (A,B). Gadolinium enhanced magnetic resonance imaging show late gadolinium enhancement is in the endocardial layer (C,D).

FIGURE 3

Photomicrograph with different magnifications (A, ×10 and B, 40×) of bone marrow biopsy showing significant proliferation of eosinophilia (deep pink cells).