Hematological dyspnea: A rare cause with gratifying recovery

A 17-year-old female was referred for evaluation of fever of two-month duration with acute onset of dyspnea since 1 week. Clinical examination revealed tachycardia, tachypnea, elevated jugular venous pressure, bilateral basal crepitations with normal heart sounds, and no murmur. Chest X-ray showed infiltrates in bilateral lung fields. Echocardiography revealed obliteration of biventricular apices along with layered thrombus over the left ventricular endocardium. Doppler studies elicited restrictive physiology with mild mitral and tricuspid regurgitation. Complete hemogram revealed hypereosinophilia with eosinophilic count of 7.4 × 10⁹/L. All secondary causes of elevated eosinophil count were excluded. The patient was started on steroids and anticoagulation. Serial echocardiograms showed clearing of the thrombus with marked symptomatic improvement. We highlight a case of idiopathic hypereosinophilic syndrome with classic cardiac (Loeffler endocarditis) and pulmonary manifestations and prompt recovery with steroids and anticoagulation. <Learning objective: Idiopathic hypereosinophilic syndrome is a rare entity leading to multi-organ involvement. Cardiac involvement is one of the most common causes of morbidity and mortality. On the basis of this case report, we discuss Loeffler endocarditis in idiopathic hypereosinophilic syndrome; demonstrate classic echocardiographic findings in the intermediate stage, and remarkable symptomatic and echocardiographic recovery after appropriate treatment.>.