Loeffler's endocarditis in a patient with a new diagnosed Churg-Strauss syndrome (CSS): A case report

Loeffler's endocarditis is a rare disease, caused by endocardial involvement of esosinophils, which damages the heart and leads to endomyocardial fibrosis with consequent restrictive cardiomyopathy, mural thrombi or valvular dysfunction. The association between Loeffler's endocarditis and Churg-Strauss syndrome (CSS) was also reported. Abnormal elevation of peripheral eosinophil counts in a heart failure patient is a hint of disease. Though echocardiography or cardiac magnetic resonance imaging (MRI) facilitates diagnosis, endomyocardial biopsy is still the gold standard. Treatments include immunosuppressive agents, anticoagulant and guideline-directed medical therapy for heart failure. A 59-year-old man presented with progressive dyspnea for one week and he was referred to our hospital for surgical treatment evaluation because valve destruction by infective endocarditis has been suspected at the local hospital. Echocardiography revealed biventricular mural thrombus and limited aortic valve opening caused by abutting thrombus. Moreover, eosinophilia, bronchial asthma, lung infiltration, acute kidney injury and positive perinuclear anti-neutrophil cytoplasmic antibody (p-ANCA) test implied Churg Strauss syndrome. Eosinophil infiltrate with fibrin thrombus was revealed by endomyocardial biopsy. The patient was diagnosed of cardiac involvement of CSS and recovered after immunosuppressive and anticoagulant treatments. Loeffler's endocarditis should be suspected when physicians encounter restrictive cardiomyopathy accompanied by mural thrombus in a patient with eosinophilia. Prompt immunosuppressive and anticoagulant medication can bring the disease under control.