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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,