Open AccessLöffler’s Endocarditis: First Report of Successful Mitral and Tricuspid Valve Replacements in a Patient with Long-Standing Hypereosinophilia
Author(s) -
MB Neil P. Naik,
MBBS Sahar Iqbal
Publication year - 2015
Publication title -
canadian journal of general internal medicine
Language(s) - English
Resource type - Journals
eISSN - 2369-1778
pISSN - 1911-1606
DOI - 10.22374/cjgim.v10i3.51
Subject(s) - hypereosinophilia , medicine , hypereosinophilic syndrome , cardiology , endocarditis , endomyocardial fibrosis , eosinophilia , endocardium , mitral valve replacement , tricuspid valve , fibrosis , mitral valve
Löffler’s endocarditis is a condition that occurs in patients with hypereosinophilic syndrome (HES). First described in 1975, HES is a relatively new syndrome that is characterized by elevated eosinophils with end organ damage. Hypereosinophilia is defined as elevated eosinophils of 1.5 x 109/L for at least one month, or tissue involvement as evidenced by bone marrow section with 20% eosinophils, tissue infiltration, and/or deposition of eosinophil granule proteins in tissue. Prevalence of HES in the United States is estimated to be 0.36–6.3/ 100,000 people, of which Löffler’s endocarditis represents only a fraction of cases. We present a case where a patient presented with palpitations and shortness of breath, with a background of chronically elevated eosinophils. HES was previously diagnosed in this patient due to persistently elevated eosinophils with lung damage (Löffler’s syndrome). On biopsy, she was found to have endomyocardial fibrosis with a thickened endocardium secondary to eosinophils. Echocardiogram showed moderate to severe regurgitation in both mitral and tricuspid valves due to regurgitation secondary to fibrosis. She subsequently underwent a successful dual valve replacement. This is the first case, to our knowledge, where a dual valve replacement was performed successfully in a patient with Löffler’s endocarditis.