İrem DİNÇER, Mustafa Fırat COŞKUN, Cebrail YARLIOĞLUEŞ, İrem Müge AKBULUT, Hüseyin GÖKSÜLÜK, Demet Menekşe GEREDE

Akut Kalp Yetmezliği ve Mezenterik Tromboembolizm ile Ortaya Çıkan İdiyopatik Hipereozinofilik Sendrom: Literatürün Gözden Geçirilmesi

Acute heart failure due to cardiac involvement of idiopathic hypereosinophilic syndrome has poor prognosis and high mortality rate. We present a 52 year old male patient with hypereosinophilic syndrome resulting in acute heart failure and mesenteric thromboembolism. Non ST elevation myocardial infarction (high troponin levels) was considered in the differential diagnosis of acute heart failure. However acute coronary syndrome was excluded with diagnostic coronary angiography. The laboratory results showed hypereosinophilia on the blood count. Cardiac magnetic resonance imaging (CMR) showed diffuse left ventricular dilatation, wall motion abnormalities and left ventricular apical thrombus without subendocardial fibrosis. He was treated according to heart failure guidelines and the patient status improved clinically. With the corticosteroid treatment, eosinophil count, C-reactive protein levels returned to normal range. Nevertheless, his clinical condition deteriorated due to massive mesenteric thromboembolism and died after cardiogenic shock and sepsis. In the pathogenesis of the disease, eosinophil derived granüls may be responsible for the cardiac damage and clinical variability that was ranging from cardiogenic shock to endomyocardial fibrosis. Early diagnosis and treatment can prevent morbidity and mortality.

Idiopathic Hypereosinophilic Syndrome Presenting With Acute Heart Failure and Mesenteric Thromboembolism: Review of the Literature

İdiyopatik hipereozinofilik sendromun kardiyak tutulumuna bağlı gelișen akut kalp yetmezliği kötü prognoza ve yüksek mortalite hızına sahiptir. Burada, akut kalp yetmezliği ve mezenterik tromboembolizme sebep olan hipereozinofilik sendromlu 52 yașında bir erkek hastayı sunuyoruz. Akut kalp yetmezliğinin ayırıcı tanısında ST yükselmeli olmayan myokart infarktüsü (troponin yüksekliği) düșünüldü. Ancak akut koroner sendrom tanısı koroner anjiyografi ile dıșlandı. Laboratuvar bulgularında hipereozinofili vardı. Kardiyak manyetik rezonans görüntülemede (MR) difüz sol ventriküler genișleme, duvar hareket bozukluğu ve subendokardiyal fibrozis olmaksızın apikal trombüs izlendi. Hasta kalp yetmezliği kılavuzuna göre tedavi edildi ve hastanın kliniği düzeldi. Kortikosteroid tedavisi ile eozinofil sayısı ve CRP seviyesi normale sınırlara geriledi. Buna rağmen masif mezenterik tromboembolizm nedeniyle hastanın klinik durumu kötülești ve kardiyojenik șok ve sepsis nedeniyle hasta kaybedildi. Hastalığın patogenezinde, eozinofil kaynaklı granüller, kardiyak hasardan ve akut kalp yetmezliğinden endomyokardiyal fibrozise kadar değișen klinik çeșitlilikten sorumlu olabilir. Erken tanı ve tedavi ile morbidite ve mortalite önlenebilir.

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