Kerala Heart Journal -Abhishek

Case report

Kerala Heart J  2016; 6(2):xx-xx. 

A rare case of acute pancarditis due to hypereosinophilia


Case report


A-40 yr old male patient presented with history of fever lasting for 3-4days  one month back followed by dyspnoea on exertion and orthopnea since 15days.

2D Echo- Showed large left atrial thrombus  4.3cm in length and 2.9cm in breadth.(fig 1)

Fig 1-2D Echo PLAX view showing LA thrombus

Right atrium also showed a thrombus 2.8cm in length and 1.6 cm in breadth adjacent to tricuspid valve protruding into right ventricle. Right ventricle also showed small thrombus. Myocardium of right ventricle also seems to be have altered echotexture.(fig 2)

Fig 2-2D Echo (short axis view aortic level) showing freely mobile thrombus in RA/RV

Pulmonary arteries were clean with no evidence of thrombus. There was no mitral or tricuspid regurgitation. Left ventricular ejection fraction was normal with no right ventricular dysfunction. Patient had moderate pericardial effusion with pericardial clot formation.(fig 3)Septal bounce was present without significant respiratory variation across mitral or tricuspid valves. So it was a case of pancarditis with all 3layers involved  i.e endocardium, myocardium and pericardium

Fig 3-2D Echo(4c view) showing LA/RA/RV thrombus,altered RV echotexture with pericardial effusion and pericardial clot


Other investigations-On subsequent blood investigation patient was found to have hypereosinophilia. No history of any drug ingestion in the recent past. No history of any helminthic infestation .Bone marrow investigation was done which turned out to be normal with no blast seen.

So it is a rare case of acute pancarditis due to hypereosinophilia. Patient was started on steroids and he improved .



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