Download 58 Y/o female with restrictive cardiomyopathy and hypereosinophilia

58 Y/o female with restrictive cardiomyopathy and hypereosinophilia
Alizadeh Sani, Zahra MD –Nabavi, Seyyed Abbas* MD
Rajaei cardiovascular Medical & Research center, Iran University of medical sciences
The case is 58 years old female that presented with common iliac artery's obstruction and
followed with new onset asthma attack .She complained from progressive dyspnea and
orthopnea. At follow up we detected hyper eosinophilia in her count blood cell.
Echocardiography showed severe ventricular diastolic dysfunction(gradeIII) compatible with
complete evidence of restrictive cardiomyopathy with fullness of both ventricoapical
segments.(Fig1) According to her blood eosinophilia the stool examination and culture was
carried out. We found strongiloides sterlecolaris. The restrictive cardiomyopathy with
ventricular apical obstruction by clot was confirmed in cardiac MRI study (Fig2) and then for
further evaluation a right heart catheterization with endomyocardial biopsy was done .
catheterization study represented infiltrative endomyocarditis. Her parasitic infection treated
with Ivermectin for one week. After that she was well and her signs and symptoms were
controlled.
(Fig1)
(Fig2)
At follow up hypercalcemia and constitutional symptoms were presented. We detected raised
tumor markers such as CEA and alpha FP and CA125. All imaging procedures such as MRI
,CT and sonography from abdomino pelvic region and thoracic cavity were negative. Bone
marrow biopsy and aspiration showed normal cellularity.
At six months follow up she complained from severe ascites.
In Pelvic sonography the ovarian mass was detected and ascites fluid was positive for
malignant cell with ovarian origin. Biopsy from pelvic mass showed ovarian
adenocarsinoma. According to the echocardiography, catheterization data and histopathology
we confirmed presence of endomyocardial fibrosis .
Endomyocardial fibrosis with hyper eosinophilia and apical obliteration by clot was highlited
hyper eosinophilic syndrome in coincidence of paraneoplastic syndrome.
Discussion:
Endomyocardal disease is common form of restrictive cardiomyopathy that categorized in
luffler endocarditis and endomyocardial fibrosis.Both of them are the result of toxic effect of
eosinophil products on myocardium.luffler endocarditis is characterized with eosinophil
count exceeding 1500/mm'3 at least for 6 mounth that can be secondary to leukemia ,parasite
infection or allergic reactions or neoplasms, with apical obliteration and colt formation.
Endomyocardial fibrosis is typically found in tropical regions that can involve left or right or
both verntricles specially in flow of both ventricles.
Key words: RCM(Restrictive
paraneoplastic syndrome
Cardio
Myopathy),
hyper
eosinophilic
syndrome,