一个陌生人的画像:心脏受累的嗜酸性细胞增多症。

IF 1.6 Q2 MEDICINE, GENERAL & INTERNAL Romanian Journal of Internal Medicine Pub Date : 2023-07-26 Print Date: 2023-12-01 DOI:10.2478/rjim-2023-0016
Andreea-Cristina Ivănescu, Alexandru Petre, Andrei Sabin Marincaș, Elisabeta Bădilă, Gheorghe-Andrei Dan
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引用次数: 0

摘要

高嗜酸性粒细胞综合征是一种罕见的临床疾病,累及心脏会导致预后不良。嗜酸性粒细胞增多性心肌炎是一种医疗紧急情况,即使在做出明确诊断之前也应立即开始有针对性的治疗。病例介绍:一名27岁女性患者因用力性呼吸困难、胸痛和疲劳住院2周。她还描述了左腿感觉异常。临床检查正常。心电图示窦性心动过速,V1-V4区QS型,弥漫性平坦T波。实验室检查显示炎症标志物增加,嗜酸性粒细胞增多,心脏酶升高,NT-proBNP升高。超声心动图显示左室功能障碍(EF 31%),而心脏MRI显示弥漫性延迟增强,主要是心内膜下倾向。肌电图提示左胫神经病变。我们将该病例解释为急需治疗的嗜酸性心肌炎,并开始大剂量糖皮质激素治疗和GDMT 4支柱心力衰竭治疗。我们排除了常见的感染性、骨髓增生性综合征和常见的相关自身免疫性疾病。使用强的松,嗜酸性粒细胞计数迅速恢复正常,我们逐渐减少剂量,每周5毫克,但继续进行心力衰竭治疗。在每月的随访中,有显著的临床改善,嗜酸性粒细胞计数正常化,心肌功能接近正常化。唯一持续存在的症状是与左胫骨神经病变相关的感觉异常。结论:令人惊讶的快速和良好的病程提供了一个高度怀疑的毒性或反应性短暂病因,但仍然不明。在我们的病例中,嗜酸性粒细胞增多的原因仍然未知,尽管我们设法缩小了可能的病因。非特异性治疗主要针对嗜酸性粒细胞增多性心肌炎,获得了令人惊讶的良好临床反应。
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The portrait of a stranger: the hypereosinophilic syndrome with cardiac involvement.

Introduction: Hypereosinophilic syndrome is a rare clinical condition, and cardiac involvement confers a poor prognosis. Hypereosinophilic myocarditis is a medical emergency and targeted treatment should be started promptly even before a definitive diagnosis could be made.

Case presentation: A 27-year-old female patient is hospitalized for exertional dyspnea, chest pain, and fatigue for the past 2 weeks. She also describes left leg paresthesias. Clinical examination was in normal limits. ECG showed sinus tachycardia, QS pattern in V1-V4, and diffuse flattened T waves. Laboratory tests revealed increased inflammatory markers, hypereosinophilia, elevated cardiac enzymes, high NT-proBNP. Echocardiography revealed LV dysfunction (EF 31%), while cardiac MRI showed diffuse delayed enhancement with predominant subendocardial disposition. The electromyogram was suggestive of left tibial nerve neuropathy. We interpreted the case as eosinophilic myocarditis with an urgent requirement of therapy and initiated high-dose glucocorticoid therapy and the GDMT 4-pillar heart failure treatment. We excluded common infectious, myeloproliferative syndromes, and frequent associated autoimmune diseases. With prednisone, the eosinophil count rapidly normalized and we gradually tapered the dose by 5 mg per week, however continuing with heart failure therapy. At monthly follow-up visits, there was a significant clinical improvement, with normalization of the eosinophilic count, and a near-normalization of myocardial function. The only symptom that persisted was paresthesias linked to left tibial neuropathy.

Conclusion: The surprisingly rapid and favorable course of the disease offers a high index of suspicion for a toxic or a reactive transitory etiology, however still unidentified. In our case, the cause of eosinophilia remained unknown, although we managed to narrow down the possible etiologies. A surprisingly good clinical response was obtained with non-specific treatment targeting mainly hyperosinophilic myocarditis.

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来源期刊
Romanian Journal of Internal Medicine
Romanian Journal of Internal Medicine MEDICINE, GENERAL & INTERNAL-
CiteScore
3.20
自引率
5.30%
发文量
35
审稿时长
15 weeks
期刊介绍: Romanian Journal of Physics is a journal publishing physics contributions on the following themes: •Theoretical Physics & Applied Mathematics •Nuclear Physics •Solid State Physics & Materials Science •Statistical Physics & Quantum Mechanics •Optics •Spectroscopy •Plasma & Lasers •Nuclear & Elementary Particles Physics •Atomic and Molecular Physics •Astrophysics •Atmosphere and Earth Science •Environment Protection
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