Loeffler’s endocarditis

Loeffler’s endocarditis

Loeffler’s endocarditis was described by Wilhelm Loffler in 1936 [1] with eosinophilic infiltration in the endomyocardial region. It can cause a restrictive cardiomyopathy similar to endomyocardial fibrosis and is associated with hypereosinophilic syndrome. Large thrombi can occur in the ventricular cavity or attached to the valves. Restriction of movement of the mitral leaflets due to eosinophilic infiltration can cause severe mitral regurgitation [2]. Such cases may need mitral valve replacement. Loeffler’s endocarditis can also present with vegetations on the valve leaflets without any involvement of the myocardium [3]. In this case there was good resolution of the vegetations with a two month course of corticosteroids.

Tricuspid valve involvement in Loeffler endocarditis also needs surgical treatment in certain cases [4]. Arrhythmias like atrial flutter can sometimes be associated with Loeffler’s endocarditis. When there is endomyocardial involvement some authors call it as Loeffler endomyocarditis [5].

ST segment and T wave changes in Loeffler endocarditis may mimic those in coronary artery disease [6]. Echocardiography is useful in Loeffler endocarditis for demonstration of valvular lesions including vegetations and thrombi as well as documenting endomyocardial involvement. Doppler echocardiography is useful in assessing severity of the regurgitant lesions.

References

1. Loffler W. Endocarditis parietalis fibroplastica mit Bluteosinophilie. Ein eigenartiges Krankheitsbild. Schweizerische medizinische Wochenschrift, Basel, 1936, 66: 817-820.
2. Tanaka H, et al. Surgical treatment for Loffler’s endocarditis with left ventricular thrombus and severe mitral regurgitation: a case report. J Cardiol. 2006 Apr;47(4):207-13.
3. Sen T et al. Hypereosinophilic syndrome with isolated Loeffler’s endocarditis: complete resolution with corticosteroids. J Postgrad Med. 2008;54:135-7.
4. Imoto Y et al. Surgical treatment of tricuspid regurgitation caused by Loffler endocarditis. Jpn J Thorac Cardiovasc Surg. 1999;47:570-3.
5. Tamura M et al. A case of surgical treatment for Löffler’s endomyocarditis. Jpn J Thorac Cardiovasc Surg. 1998;46:455-60.
6. Maruyoshi H et al. Loffler’s endocarditis associated with unusual ECG change mimicking posterior myocardial infarction. Heart Vessels. 2003;18:43-6.