Loffler endocarditis: When Hypereosinophilia is a route changer and echo is a pathfinder. A case report

Background and aim: Loeffler endocarditis is a rare complication of eosinophilic granulomatosis with polyangiitis. It is a heart infiltrative disease. Even if echocardiography is not the gold standard for tissue characterization, it can be important for an optimized diagnostic strategy. This report aims to highlight imaging nuances that can be helpful for a better Loeffler endocarditis diagnosis Case summary: This is the case of a Caucasian 67-year-old woman with a history of adult-onset asthma. She complained of increased dyspnea. Physical examination and electrocardiogram were non-specific. hypereosinophilia and immunological tests allowed the diagnosis of eosinophilic granulomatosis. Echocardiography showed a left ventricle apical mass with specific characteristics identified by conventional, 2D, and Doppler modes and further by Tissue Doppler and speckle tracking imaging. Cardiac magnetic resonance identified fibrosis centered by a thrombus. We retained the diagnosis of stage 2 to 3 Loeffler endocarditis, and corticoids and anticoagulants were used for treatment with a short-term favorable outcome and symptom relief. Conclusion: In eosinophilic granulomatosis with polyangiitis patients, echocardiography should actively search for ventricular fibrosis, thrombi, myocardial dysfunction, and valve abnormalities. All of them are highly important and useful for Loeffler endocarditis at time diagnosis and management planning