Email this article An arrhythmic variant of the manifestation of paraneoplastic Loeffler endomyocarditis. Clinical case
- Authors: Grishkin Y.N.1, Zimina V.Y.1, Babayan A.A.2, Karchikian P.O.2, Butayev T.D.1, Grigorieva O.V.2
-
Affiliations:
- North-Western State Medical University named after I.I. Mechnikov
- City Pokrovskaya Hospital
- Issue: Vol 4, No 2 (2024)
- Pages: 29-40
- Section: Case reports
- URL: https://journal-vniispk.ru/cardar/article/view/269903
- DOI: https://doi.org/10.17816/cardar635455
- ID: 269903
Cite item
Abstract
A clinical case of chronic undulating course of parneoplastic Loeffler endomyocarditis, the leading manifestations of which were ventricular arrhythmias, is presented. The paper demonstrates the complexity of early diagnosis of a rare pathology in a polymorbid patient and attempts to identify the "keys" to the correct diagnostic and therapeutic tactics for managing such patients.
Full Text
##article.viewOnOriginalSite##About the authors
Yuri N. Grishkin
North-Western State Medical University named after I.I. Mechnikov
Email: yurigrishkin@yandex.ru
SPIN-code: 9997-2073
MD, Dr. Sci. (Med.), professor
Russian Federation, Saint PetersburgVera Yu. Zimina
North-Western State Medical University named after I.I. Mechnikov
Email: Vera.Zimina@szgmu.ru
ORCID iD: 0000-0002-5655-8981
SPIN-code: 7202-1071
MD, Cand. Sci. (Med.)
Russian Federation, Saint PetersburgAnahit A. Babayan
City Pokrovskaya Hospital
Author for correspondence.
Email: babayan.anahit24@gmail.com
ORCID iD: 0009-0001-0898-2622
cardiologist
Russian Federation, Saint PetersburgPavel O. Karchikian
City Pokrovskaya Hospital
Email: p1472141@mail.ru
ORCID iD: 0000-0001-8288-0352
SPIN-code: 3138-0839
MD, Cand. Sci. (Med.)
Russian Federation, Saint PetersburgTamerlan D. Butayev
North-Western State Medical University named after I.I. Mechnikov
Email: butayevtd@yandex.ru
ORCID iD: 0009-0005-8314-808X
MD, Cand. Sci. (Med.)
Russian Federation, Saint PetersburgOksana V. Grigorieva
City Pokrovskaya Hospital
Email: ovg-spb-6868@mail.ru
pathologist
Russian Federation, Saint PetersburgReferences
- Hoffman R, Edward J, Benz E, et al. Hematology, basic principles and practice. 8th edition. Elsevier; 2022;1243–1257. doi: 9780323733892
- Loeffler W. Scientific raisins from 125 years SMW (Swiss Medical Weekly). 2nd international medical week dedicated in Switzerland. Luzern, 31 August — 5 September 1936. Fibroplastic parietal endocarditis with eosinophilia. An unusual disease. 1936. Schweizerische Medizinische Wochenschrift. 1995;125:1837–1840. (In German.)
- Chao BH, Cline-Parhamovich K, Grizzard JD. Fatal Loeffler’s endocarditis due to hypereosinophilic syndrome. Am J Hematol. 2007;82(10):920–923. doi: 10.1002/ajh.20933
- Crane MM, Chang CM, Kobayashi MG, Weller PF. Incidence of myeloproliferative hypereosinophilic syndrome in the United States and an estimate of all hypereosinophilic syndrome incidence. J Allergy Clin Immunol. 2010;126(1):179–181. doi: 10.1016/j.jaci.2010.03.035
- Mubarik A, Iqbal AM. Loeffler Endocarditis. [Updated 2024 Jan 7]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing, 2024 Jan. — [cited 2024 Sept 18] Available from: https://www.statpearls.com/point-of-care/21092
- Ogbogu PU, Rosing DR, Horne MK 3rd. Cardiovascular manifestations of hypereosinophilic syndromes. Immunol Allergy Clin North Am. 2007;27(3):457–475. doi: 10.1016/j.iac.2007.07.001
- Otto KM. Clinical echocardiography: a practical guide / transl. from English; ed. by Sandrikov VA; edited by Galagudza MM, Domnitskaya TM, Zelenikin MM, et al. Moscow: Logosphere; 2019. P. 688–690. EDN: BUAHUQ
- Vereckei A, Duray G, Szénási G, et al. New algorithm using only lead AVR for differential diagnosis of wide QRS complex tachycardia. Heart Rhythm. 2008;5(1):89–98. doi: 10.1016/j.hrthm.2007.09.020
- Lobo R, Jaffe AS, Cahill C, et al. Significance of high-sensitivity troponin t after elective external direct current cardioversion for atrial fibrillation or atrial flutter. Am J Cardiol. 2018;121(2):188–192. doi: 10.1016/j.amjcard.2017.10.009
- Stevenson WG, Friedman PL, Sager PT, et al. Exploring postinfarction reentrant ventricular tachycardia with entrainment mapping. J Am Coll Cardiol. 1997;29(6):1180–1189. doi: 10.1016/s0735-1097(97)00065-x
- Turkina AG, Nemchenko IS, Tsyba NN, et al. Clinical guidelines for the diagnosis and treatment of myeloproliferative diseases associated with eosinophilia. 2018. 30 р. (In Russ.) EDN RTBSCM
- Butt NM, Lambert J, Ali S, et al. British committee for standards in haematology. Guideline for the investigation and management of eosinophilia. Br J Haematol. 2017;176(4):553–572. doi: 10.1111/bjh.14488
- Groh M, Rohmer J, Etienne N et al. French guidelines for the etiological workup of eosinophilia and the management of hypereosinophilic syndromes. Orphanet J Rare Dis. 2023;18(1):100. doi: 10.1186/s13023-023-02696-4
- Medscape [Internet]. Samavedi VA, Sacher RA, Herrin VE, et al. Hypereosinophilic syndrome clinical presentation. [cited 2024 Sep. 18]. Available from: https://emedicine.medscape.com/article/202030-clinical
Supplementary files
Supplementary Files
Action
1.
JATS XML
2.
Fig. 1. ECG on October 17, 2023. Sinus rhythm with a rate of 88 per minute. Cardiac rotation of the right ventricle anteriorly and the apex posteriorly. Left atrium enlargement. Disseminated diffuse myocardial changes
Download (2MB)
3.
Fig. 2. ECG on November 4, 2023. Monomorphic reciprocal left ventricular tachycardia with a rate of 131 per minute. QRS complex is 150 ms and has the shape of a complete RBBB and LAFB, R-shape in aVR lead, and Vi/Vt ratio < 1 in V5 lead. The regular fluctuations of the R-R intervals can be explained by conduction through reentry loops of different sizes
Download (1MB)
4.
Fig. 3. ECG no. 2, November 4, 2023. Monomorphic reciprocal left ventricular tachycardia with a rate of 157 per minute. QRS complex is 150 ms, in the form of a complete RBBB and LAFB, R-shape in the aVR lead, and r/S ratio in the V6 lead < 1
Download (1MB)
5.
Fig 4. Sinus tachycardia ~100 per minute. Left ventricular extrasystole with complete compensatory pause, having the form of a complete RBBB and LAFB, similar to the form of QRS complexes in tachycardia. Overload of the left atrium
Download (893KB)
6.
Fig. 5. Echocardiogram of Loeffler endomyocarditis of the LV. Four-chamber view, apical approach. The arrows indicate wall masses in the area of the akinetic apex and in the projection of myocardium with preserved local contractility. The border between the myocardium and myocardial projections is clearly visible. The wall masses and myocardium have different densities, and there is an obvious boundary between them. Vertical arrows indicate extensive wall masses initially believed to be thrombus; horizontal arrow indicates LV myocardium
Download (266KB)
7.
Fig. 6. Echocardiographic changes in the right ventricular outflow tract: a — short-axis view at the level of the aortic valve, subcostal approach, reveals parietal masses located in the outflow tract of the right ventricle, indicated by the lower arrow. The arrows above and to the right delineate the myocardium of the right ventricle and a clear boundary between the myocardium and the parietal deposits. For comparison; panel b — displays the same section from a healthy individual,demonstrating a non-thickened right ventricular myocardium absent of pathological parietal masses
Download (371KB)
8.
Fig. 7. Macroscopic sections in the LV apex: а — two adjacent foci of necrosis of pale yellow color (black arrows); b — thickened, inflamed endocardium of pale pink color. Intact endocardial areas are marked with black arrows and damaged areas with white arrows
Download (503KB)
9.
Fig. 8. Histological section of the endocardium and adjacent myocardium: a — endocardium; b — focus of necrosis; c — myocardium. At the border of the endocardium and myocardium, signs of necrosis of both endocardium and adjacent myocardium are noted. In the zone of endocardial necrosis, the presence of necrotic tissue, fibrin, and hemolyzed blood elements is observed. In the adjacent myocardium, similar changes are found: signs of necrosis, overgrowth of granulation tissue, and massive infiltration of the whole area with lymphocytes, plasmocytes, and eosinophils
Download (761KB)
