Syndrome d’hyperéosinophilie avec atteinte cardiaque

We report the case of a 30-year old man with no previous medical history and without cardiovascular risk factors, hospitalized for NYHA Class IV dyspnoea associated with palpitations in the Department of Cardiology. Clinical examination showed signs of cardiac decompensation. The patient didn't have fever, hepatosplenomegaly and palpable lymphadenopathies. Laboratory tests showed hypereosinophilia greater than 4000 eosinophils per cubic millimeter. Electrocardiogram objectified atrial tachycardia at a rate of 100 beats per minute. Echocardiographic examination showed good left ventricular function, dilation of both atria and a thrombus filling the right ventricular apex. The diagnosis of thrombus lining the ventricular apex was suspected (A, B); successive exams showed progressive filling of the right ventricular apex. Cardiac MRI showed apical filling of both ventricles and after intravenous injection of gadolinium, late subendocardial enhancement in the left ventricular apex and in the right ventricular apex, suggesting fibrosis (C, D). Etiologic investigation of hypereosinophilia excluded parasitic diseases, drug therapies, neoplasias and autoimmune diseases as a cause. The diagnosis of idiopathic hypereosinophilic syndrome associated with cardiac involvement was retained. Corticosteroid therapy associated with hydroxyurea therapy and long-term anticoagulant therapy were started. Patient's evolution was gradually favorable with disappearance of hypereosinophilia.