Löffler Endocarditis and Endomyocardial Fibrosis
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Matthew J. Flanigan
A 65-year-old man presented to a medical center with dyspnea, peripheral edema, and orthopnea. Diagnosis of chronic systolic and diastolic biventricular heart failure secondary to Löffler endocarditis and endomyocardial fibrosis was made. A transthoracic echocardiograph showed a reduced left ventricular ejection fraction and severe right ventricular systolic dysfunction. The right ventricular cavity was nearly obliterated by a homogeneous mass, and spectral Doppler ultrasonography demonstrated diminished antegrade systolic flow across the pulmonic valve. Anticoagulation therapy with heparin was initiated. Cardiac magnetic resonance image revealed diffuse hyperenhancement of the right ventricular free wall on delayed gadolinium enhancement (image A, arrow). Catheterization of the right side of the heart with contrast ventriculogram revealed a nearly obliterated (image B, dotted line) right ventricle with interatrial passage of contrast and subsequent left ventricular opacification (image B, arrows). A 35-cm ultrasound-accelerated thrombolysis catheter was placed in the left pulmonary artery. Hemodynamic measurements demonstrated atrialization of the right ventricular pressure waveform. Hemodynamics failed to improve after 18 hours of thrombolysis, and the patient died of complications of biventricular heart failure 10 days after presentation.
Löffler endocarditis and endomyocardial fibrosis, when encountered together, is rare and characterized by peripheral eosinophilia and the development of endomyocarditis, intracardiac thrombosis, and eventual cardiac fibrosis.1 Patients with peripheral eosinophilia have been successfully treated with systemic steroids or eradication of the underlying parasitic infection.2,3 Thrombectomy to manage intracardiac thrombosis secondary to Löffler endocarditis has been reported with variable results.4,5
References
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3. Kawano S , KatoJ, KawanoN, et al.Clinical features and outcomes of eosinophilic myocarditis patients treated with prednisolone at a single institution over a 27-year period.Intern Med. 2011;50:975-978.10.2169/internalmedicine.50.4079Search in Google Scholar PubMed
4. Tanaka H , KawaiH, TatsumiK, et al. Surgical treatment for Löffler's endocarditis with left ventricular thrombus and severe mitral regurgitation: a case report. J Cardiol. 2006;47(4):207-213.Search in Google Scholar
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Articles in the same Issue
- STILL RELEVANT?
- Mother Still
- ORIGINAL CONTRIBUTION
- Pennsylvania Otolaryngologists as a Model for the Implications of Practice Location of Osteopathic vs Allopathic Surgical Subspecialists
- BRIEF REPORT
- Single Osteopathic Manipulative Therapy Session Dampens Acute Autonomic and Neuroendocrine Responses to Mental Stress in Healthy Male Participants
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- JAOA/AACOM MEDICAL EDUCATION
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- SPECIAL COMMUNICATION
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