Löffler's Eosinophilic Endocarditis

Most cases are of idiopathic origin.

However other causes include:

• Hypereosinophilic syndrome
• Eosinophilic leukaemia
• Carcinoma
• Lymphoma
• Drug reactions
• Parasites

• The usual presentation is with weight loss, fever, cough, a rash (possibly pruritic) and symptoms of congestive heart failure.
• Early cardiac involvement occurs in 20 to 50% of cases.
• The physical findings are those of heart failure:
  • Peripheral oedema and elevated jugular venous pressure
  • Tachycardia
  • Cardiomegaly may precede signs of heart failure
  • There may be a murmur of mitral regurgitation as described in mitral valve disease
  • The gallop of a 3rd heart sound may be heard and possibly even a 4th heart sound
• Systemic emboli may cause renal or neurological problems.
• Signs of a restrictive cardiomyopathy may be very similar to those of constrictive pericarditis but the presence of a palpable apex beat and mitral regurgitation suggest cardiomyopathy.

• Other causes of restrictive cardiomyopathy include amyloidosis, sarcoidosis and myeloma.
• In children rhabdomyosarcoma may be found. It is commoner with tuberose sclerosis.

• Full blood count will show marked eosinophilia - at least 0.44 x 10⁹/l
• Electrocardiogram, echocardiogram and possibly CT scan and biopsy - useful to diagnose cardiomyopathy (Löffler's cardiomyopathy is characterised by restrictive filling but quite good left ventricular systolic function)
• Cardiac catheterisation

• Congestive failure is treated in the usual way with diuretics, digoxin, ACE inhibitors and other drugs to reduce afterload.
• In early disease, immune suppression and cytotoxic drugs have had variable success.²
• Steroids appear of benefit in acute myocarditis.
• Prednisolone and hydroxycarbamide have been used to suppress eosinophilia.
• Once fibrosis has occurred, surgery may be of benefit:
  • Removing fibrosed endocardium may improve elasticity.
  • Mitral and even tricuspid valves may need replacement.
  • Operative mortality is 15-30% and complete atrioventricular (AV) block is a common complication.

• Prognosis is poor and depends upon the degree of involvement of the heart. Onset is usually slow but with accelerating right and left heart failure.
• Syncope and sudden death are less common than with other constrictive cardiomyopathies.
• The mean survival time is 18 months.³