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Updated: Jun 21, 2025
Author Spotlight: Investigating the Pathophysiology of Eosinophilic Esophagitis
Published on: May 10, 2024
The three stages of eosinophilic cardiac damage: A series of case reports
Joana Ferreira1, Sara Gonçalves1, Tatiana Duarte1
1Department of Cardiology, Centro Hospitalar de Setúbal, Setúbal, Portugal.
Insights
Hypereosinophilic syndrome can cause heart damage in distinct stages. Even when eosinophil counts normalize, continued cardiac monitoring is crucial due to dissociated clinical evolution.
Area of Science:
- Cardiology
- Hematology
- Immunology
Background:
- Hypereosinophilic syndrome (HES) is a rare disorder causing organ damage via eosinophils.
- Cardiac involvement is a frequent and serious complication of HES, progressing through defined stages.
Observation:
- This study presents two cases of HES with cardiac involvement, illustrating sequential stages of eosinophilia-mediated myocardial disease.
- Multimodality imaging played a critical role in diagnosing these complex cardiac presentations.
Findings:
- The cases highlight a significant dissociation between blood eosinophil counts and the clinical progression of cardiac disease in HES.
- Eosinophil levels alone do not accurately reflect the patient's clinical status or the ongoing cardiac damage.
Implications:
- Close cardiac follow-up is essential for HES patients, even after eosinophil counts have normalized.
- Relying solely on eosinophil counts for monitoring clinical evolution in HES can be misleading.
- This underscores the need for comprehensive, long-term cardiac surveillance in managing hypereosinophilic syndrome.
Abstract:
Hypereosinophilic syndrome is a rare systemic condition characterized by eosinophil-mediated organ damage. Cardiac involvement is common and typically occurs in sequential stages. We present two cases that demonstrate these different stages and presentations of eosinophilia-mediated myocardial disease, where multimodality imaging was essential for the diagnosis. More importantly, they demonstrate, for the first time, the dissociation between the eosinophil count and patients' clinical evolution, suggesting the need for close follow up even after the eosinophilia has been controlled.
Learning Objective:
Cardiac involvement in hypereosinophilic syndrome typically occurs in three stages - necrotic, thrombotic, and fibrotic. Although cardiac damage is mediated by eosinophils, the blood eosinophil count and patients' clinical evolution are dissociated. Therefore, eosinophil count on its own is not an adequate marker of clinical evolution, and cardiac follow up should be continued even after the eosinophilia has been controlled.
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