European Heart Journal Advance Access published July 18, 2015

CARDIOVASCULAR FLASHLIGHT

doi:10.1093/eurheartj/ehv310

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Cardiac magnetic resonance imaging: a tool to diagnose parasitic infection? Alexander Loch*, Daniel Joseph Geh, and Ramesh Singh Veriah Univeristy Malaya Medical Centre, Kuala Lumpur 59100, Malaysia

* Corresponding author. Email: [email protected]

Published on behalf of the European Society of Cardiology. All rights reserved. & The Author 2015. For permissions please email: [email protected].

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A 48-year-old Somali camel farmer presented with symptoms of heart failure. He reported a 1 year history of exertional dyspnoea, loss of appetite, and weight loss. Clinically, there were signs of right heart failure with ascites and splenomegaly. Blood tests were unremarkable apart from an elevated eosinophil count of 1750 mm23. Echocardiogram demonstrated a mass within the left ventricle (Panels A and B), a normal ejection fraction (65%), moderate mitral regurgitation, and severe tricuspid regurgitation with elevated pulmonary artery systolic pressure (102 mmHg). Cardiac magnetic resonance imaging (MRI) was performed. Early gadolinium images demonstrated the mass within the normally contracting left ventricle to be a large thrombus measuring 2.2 × 4.0 cm (Panel C). There was late gadolinium enhancement of both the left and right subendocardial walls consistent with fibrosis, extending from the subvalvular areas to the apex (Panel D). Magnetic resonance imaging also demonstrated bilateral pulmonary effusions. A diagnosis of restrictive cardiomyopathy secondary to hypereosinophilic syndrome was made. A workup for secondary causes of hypereosinophilia detected strongyloides stercoralis infection on stool polymerase chain reaction. Strongyloides is the most common human parasite. Exposure often occurs with agricultural activities during skin contact with infected soil. The patient was treated with prednisolone and warfarin. Albendazole was administered for parasite eradication. A thrombus within a normally contracting left ventricle is extremely rare. The MRI pattern in hypereosinophilic cardiac disease is pathognomonic and MRI is an alternative to cardiac biopsy in this condition. Cardiac MRI may be a useful tool for the detection of occult parasitic infection.

Cardiac magnetic resonance imaging: a tool to diagnose parasitic infection?

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