Hyper eosinophilic Syndrome Complicated by Eosinophilic Myocarditis: Embolic Stroke or Eosinophilic Stroke? A Case Report

Hyper eosinophilic syndrome (HES) is traditionally described as chronic peripheral eosinophilia with involvement of various organs and systems such as heart and nervous system. In this report we describe cardiac involvement and border zone stroke in a patient with idiopathic HES. A 37-year-old woman presented with sudden right-sided weakness, Slurring of speech since 4 days before admission, and palpitation, retrosternal exertional chest discomfort, dry cough, and progressive shortness of breath for about 2 months. Preliminary studies indicated an increased number of white blood cells with eosinophilia. Further diagnostic investigation indicated the presence of apical thrombosis in both ventricles of the heart and moderate left ventricular systolic dysfunction. Magnetic resonance imaging(MRI) for evaluating the brain showed multifocal infarction of anterior and posterior border zones, as well as both cerebellar hemispheres, with a greater concentration on the left side. Consequently, the patient was diagnosed with idiopathic HES.Therefore the patient received corticosteroid, cyclophosphamide, anticoagulant, and medicines for heart failure and responded clinically and hematologically. Our case highlights the importance of multiple imaging modalities in the diagnostic process of eosinophilic endomyocarditis as well as the impact of timely medical treatment to prevent disease progression.