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Hypereosinophilic Syndrome Presented with Myocardial Infarction with Non-Obstructive Coronary Arteries: A case Report
Ali Mohammad Haji Zeinali1 , Mahzad Bekravi *2
1- Department of interventional cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
2- Department of interventional cardiology, Tehran Heart Center, Tehran University of Medical Sciences , M_bekravi@yahoo.com
Abstract:   (150 Views)
Hypereosinophilic syndrome (HES) characterized by persistent eosinophilia without any discernible underlying cause. The patient might exhibit no symptoms at all or may manifest a disorder affecting multiple systems.  Electrocardiography, echocardiography and cardiac magnetic resonance imaging are commonly used methods to assess cardiac involvement in HES. Recognizing HES early can be difficult since the initial stage typically lacks noticeable clinical symptoms. Here, we report a 45-years-old man with HES which mimics the acute coronary syndrome signs and symptoms, after ruling out other possible diagnoses, Electrocardiography revealed inverted T-waves in pericardial leads (V4–V6). Coronary angiography demonstrated non-obstructive coronary artery disease. Echocardiography showed moderate left ventricular (LV) hypertrophy, a lobulated apical LV mass, trivial tricuspid regurgitation, and mild pleural effusion. Cardiac MRI identified an apical LV mass with iso/high signal intensity on STIR sequences and no enhancement on late gadolinium enhancement (LGE), consistent with LV thrombus in the setting of HES. On admission, troponin level was 869 ng/ml. HES was confirmed and the patient was treated with prednisolone (5 mg/kg daily) and apixaban (10 mg BID for 7 days, then 5 mg BID). Follow-up demonstrated a decrease in troponin to 351 ng/ml and complete resolution of the LV thrombus on echocardiography.
 
Keywords: Myocardial Infarction with Non-Obstructive Coronary Arteries, Eosinophil, Hypereosinophilic syndrome.
     
Type of Study: Case Report Article | Subject: Clinical Medicine
Received: 2025/06/10 | Accepted: 2026/06/22
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