P1685 Loeffler endocarditis mimicking myocardial infarction

Abstract

Abstract Loeffler endocarditis is a major cause of morbidity and mortality in patient with hypereosinophilia-associated syndromes. It is a rare disease that occurs due to eosinophilic inflammation of the endocardium with fibrosis and thrombus formation. We describe a case of Loeffler endocarditis with unusual clinical course. 61-year-old woman was admitted due to chest pain and elevated troponin I level. Her past medical history was remarkable for persistent asthma, rhinitis, and productive cough for almost 1 year. Laboratory test revealed hypereosinophilia. Further workup for parasitic diseases, allergy, malignancy, hematological causes were all negative Coronary angiography excluded coronary artery disease. Transthoracic echocardiography (TEE) showed endocardium thickening at the septal left ventricular wall, diastolic dysfunction (Grade II), and moderate pericardial effusion (Figure 1A). Cardiac magnetic resonance imaging (cMR) confirmed endocardial inflammation. The Loeffler endocarditis was diagnosed and corticosteroid treatment was started. After one year the patient was asymptomatic, TEE showed improvement of left ventricular diastolic function (Grade I) and complete regression of myocardial thickening (Figure 1B). Therefore, corticosteroids were slowly tapered. After 16 months she relapsed with severe chest pain, marked eosinophilia and elevated troponin I level. Left ventricular systolic function rapidly deteriorated to ejection fraction of 40%. Urgent cMR showed diffuse edomyocardial inflammation with apical thrombus formation. She was immediately treated with high doses of corticosteroid and heparin, which resulted in systolic function normalization and thrombus disappearance. In conclusion, Loeffer endocarditis still represents diagnostic challenge, may have unpredictable clinical course and generally respond well to corticosteroid treatment in early stages. Abstract P1685 Figure 1.