Abstract
Background: Eosinophilic (Loeffler’s) endomyocarditis is a restrictive cardiomyopathy caused by eosinophilic infiltration of myocardial. Complications include arrhythmias, intraventricular thrombus formation, and acute heart failure. Clinical Presentation A 37-year-old man with no past medical history presented with two weeks of fatigue and exertional dyspnea. He was found to have acute eosinophilic leukemia with a total white blood cell count of 440 k/mm^3 with 14% myelocytes, hypereosinophilic syndrome with an absolute eosinophil count of 56 k/mm^3, severe anemia and thrombocytopenia. Bone marrow biopsy and peripheral blood FISH analysis confirmed eosinophilic leukemia. He subsequently underwent leukopheresis, followed by treatment with hydroxyurea and imatinib. Cardiac Evaluation Echocardiogram revealed endomyocardial thickening of the left ventricular apex (Figure 1A). Cardiac MRI revealed left ventricular apical subendocardial wall thickness of 16 mm with subendocardial late gadolinium enhancement consistent with endomyocardial fibrosis (Figure 1B). The average global T1 value was 1100 ms and the calculated extracellular volume was 35%. MRI also revealed an apical left ventricular thrombus. The patient was treated with pulse dose of steroids in addition to the cancer-specific regimen. He did not initially receive anticoagulation due to severe anemia and thrombocytopenia. Subsequent echocardiography after three months of treatment revealed complete resolution of endomyocardial thickening and no evidence of a left ventricular thrombus. He had resolution of peripheral leukocytosis, hypereosinophilia, anemia, and thrombocytopenia. Conclusion This case presents the diagnosis and multidisciplinary management of eosinophilic endomyocarditis related to eosinophilic leukemia. Complete clinical and echocardiographic resolution was achieve following treatment with pulse-dose steroids and a cancer-specific regimen.
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