One Step Before Eosinophilic Cardiomyopathy

A 57–year–old woman was admitted to our Emergency Department (ED) for chest pain, cough, and fever that appeared a few days before. She was affected by bronchial asthma since childhood. The EKG showed a new–onset right bundle block, and the blood samples increased myocardionecrosis markers. A coronary angiography was performed showing coronary arteries free from lesions. Therefore, a transthoracic echocardiogram demonstrated a significant diastolic dysfunction with reduced global longitudinal strain (GLS). A cardiac magnetic resonance (CMR) showed mildly reduced left ventricle ejection fraction (LVEF) with hyper–intensity of the anterolateral wall. The high–resolution chest tomography (HRCT) showed: diffuse parenchymal thickenings, partly with a ribbon–like morphology and a ground–glass appearance. A high eosinophil count was observed in peripheral blood and bronchoalveolar lavage (BAL) during hospitalization. To conclude, even a healthy person with an atopic pre–disposition may experience a hypersensitivity reaction to an inhaled antigen and develop a lung or cardiac affection. Our patient’s symptoms improved with high–dose steroids, as well as the chest computed tomography and the transthoracic echocardiogram showed a general improvement. This may be justified with a possible immune–related origin of the pathology so that eosinophilic pneumonia may be thought to represent the stage before Loeffler endocarditis.