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Case report
When multimodality cardiac imaging saves the day: rare cause of embolic strokes
  1. Polyvios Demetriades1,
  2. Laura Speke2,
  3. Lowella Wilson2 and
  4. Jamal Nasir Khan2
  1. 1Cardiology, Queen Elizabeth Hospital Birmingham, Birmingham, UK
  2. 2Cardiology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
  1. Correspondence to Dr Polyvios Demetriades; polyvios.demetriades{at}


Hypereosinophilic syndrome (HES) is a rare disorder characterised by eosinophilic infiltration of tissues. Myocardial infiltration occurs in 50%–60% of HES and leads to a condition called Loeffler’s endocarditis. This can lead to endomyocardial injury with resultant superimposed thrombus formation and embolic stroke. We describe the case of a 57-year-old female patient presenting with neurological symptoms who was found to have multiple embolic strokes on a background of long-standing eosinophilia. Following a series of investigations, including transthoracic and transoesophageal echocardiographies and cardiovascular MRI, she was confirmed to have Loeffler’s endocarditis with left ventricular thrombus. She was treated successfully with steroids and anticoagulation. We describe the pathophysiology of HES and Loeffler’s endocarditis and stress the crucial role of multimodality cardiac imaging in establishing its diagnosis and treatment monitoring.

  • cardiovascular medicine
  • heart failure
  • stroke
  • clinical diagnostic tests

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  • Contributors PD has been involved in the patient’s cardiac investigations, collected the data, wrote the manuscript, prepared the figures and submitted the case report. JNK has reviewed the manuscript and figures and has made adjustments and changes and finalised the submission. LW and LS were involved in patients’ investigations and have contributed in reviewing the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.