LOEFFLER ENDOCARDITIS PRESENTING AS RECURRENT CARDIOEMBOLIC STROKES

Document Type

Conference Proceeding

Publication Date

4-1-2024

Publication Title

J Am Coll Cardiol

Abstract

Background Loeffler endocarditis (LE) describes endomyocardial disease due to eosinophilic infiltration in hypereosinophilic syndrome (HES). Rarely, valvular disease occurs, in some cases acting as a nidus for thromboembolism. Case A 77-year-old woman presented with acute right-sided visual loss. History was notable for asthma, rhinosinusitis, and a cryptogenic stroke four months earlier. Laboratory workup showed eosinophilic leukocytosis and elevated inflammatory markers. Infectious workup was unremarkable. Head imaging demonstrated multiple strokes of variable age and distributions, concerning for cardioembolic stroke. Transesophageal echocardiography revealed mitral valve disease consistent with HES causing LE. [Formula presented] Decision-making Our patient met diagnostic criteria for idiopathic HES with persistent eosinophilia and organ involvement. She was managed with steroids and anticoagulation with warfarin to reduce the risk of recurrent stroke. Definitive management in LE with mitral valve disease is surgical valve replacement, biological valves are preferred due to less valve thrombosis. Our patient was deemed not a surgical candidate, she was planned for future reconsideration if recurrent strokes occur. Six months later, she had no further strokes and echocardiography showed stable mitral valve disease. Conclusion LE is managed with eosinophilia suppression, therapeutic anticoagulation for thromboembolism management, and surgical valve replacement for valvular disease.

Volume

83

Issue

13

First Page

2990

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