Loeffler's Endomyocarditis With Embolic Stroke Secondary to Chronic Eosinophilic Leukemia With Therapy-Related Molecular Features
Recommended Citation
Ramesh S, Yousif N, Affas Z, Bajouka J, Haddad J, Thacker H, Zughaib M. Loeffler’s Endomyocarditis with Embolic Stroke Secondary to Chronic Eosinophilic Leukemia with Therapy-Related Molecular Features. JACC Case Rep. 2026;109890.
Document Type
Article
Publication Date
10-14-2026
Publication Title
JACC Case Rep
Abstract
BACKGROUND: Loeffler’s endomyocarditis is a severe manifestation of hypereosinophilia characterized by eosinophil-mediated myocardial injury, mural thrombus formation, and endomyocardial fibrosis. While often idiopathic, it may arise from clonal eosinophilic disorders carrying higher risk of end-organ damage. CASE SUMMARY: A 77-year-old man with diffuse large B-cell lymphoma in remission presented 5 years after R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone) chemotherapy with subacute confusion and dyspnea. Echocardiography demonstrated a large apical left ventricular thrombus with mildly reduced systolic function. Cardiac magnetic resonance revealed diffuse subendocardial late gadolinium enhancement. Progressive eosinophilia (peak: 3.07 × 10(9)/L) with cytopenias prompted a bone marrow biopsy, which revealed chronic eosinophilic leukemia with monosomy 7 and pathogenic mutations, raising concern for a therapy-related clonal process. Despite emergent systemic anticoagulation followed by high-dose corticosteroids, brain magnetic resonance imaging showed multifocal embolic infarcts. DISCUSSION: This case highlights clonal, potentially therapy-related eosinophilia as an under-recognized cause of Loeffler’s endomyocarditis, requiring early diagnosis to prevent irreversible fibrosis and embolic complications.
PubMed ID
42644796
Volume
31
Issue
41
First Page
109890
Last Page
109890
