A 40-year-old woman from El Salvador presented with 3 months of abdominal pain and diarrhea followed by 2 weeks of atypical chest pain and exertional dyspnea and was diagnosed with eosinophilic endocarditis secondary to Strongyloides stercoralis infection. Transthoracic echocardiogram revealed apical masses in the left and right ventricles and a thickened posterior mitral valve leaflet and cardiac magnetic resonance imaging confirmed the presence of a left ventricular apical mass with diffuse subendocardial delayed enhancement consistent with endocardial fibrosis. In conclusion, eosinophilic endocarditis is a rare cause of restrictive cardiomyopathy characterized by endomyocardial fibrosis and apical thrombosis and fibrosis with frequent involvement of the posterior mitral valve leaflet.
Eosinophilic endocarditis (Loeffler endocarditis) is an uncommon cause of restrictive cardiomyopathy resulting from endomyocardial thrombosis and fibrosis as a result of toxins released by infiltrating eosinophils. It is classically thought to be comprised of 3 stages: the necrotic stage, the thrombotic stage, and the fibrotic stage. We describe typical echocardiographic and cardiac magnetic resonance imaging (MRI) findings in a patient with eosinophilic endocarditis related to Strongyloides stercoralis infection.
Case Description
A 40-year-old woman from El Salvador presented with 3 months of abdominal pain, diarrhea, nausea, vomiting, and weight loss followed by 2 weeks of atypical chest pain and exertional dyspnea. Initial chest x-ray revealed cardiomegaly and mild pulmonary edema. Further workup revealed a peripheral eosinophilia of 2.2 × 10 9 /L (normal 0.05 to 0.50 × 10 9 /L), a troponin I of 0.31 μg/L, and an electrocardiogram consistent with left ventricular (LV) hypertrophy. Transthoracic echocardiogram showed a large mass in the LV apex and a small mass in the right ventricular apex ( Figure 1 ; Supplemental Videos 1, 2 ). The posterior mitral valve leaflet was thickened and had reduced mobility ( Figure 1 ), resulting in significant mitral regurgitation. Doppler interrogation revealed a mitral inflow pattern consistent with restrictive filling ( Figure 1 ) and an estimated right ventricular systolic pressure of 69 mm Hg. Cardiac MRI confirmed a 4.3 × 3.4 × 3.5 cm nonenhancing mass in the LV apex ( Figure 1 ; Supplemental Video 3 ) and diffuse subendocardial delayed enhancement ( Figure 1 ) with increased signal on edema and diffusion weighted sequences.
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