Laburpena
Mural thrombi and thromboemboli are very common in idiopathic hypereosinophilic syndrome (HES), whose cardiac pathology is indistinguishable from endomyocardial fibrosis (EMF). Although mural thrombi are common in EMF cases, and post mortem embolic infarcts are frequently seen; clinical recognition of thromboembolism in EMF is unusual. We report here 4 cases of clinically recognized thromboembolism among 106 consecutive cases of EMF (including a case with a sudden onset of vascular occlusion and a below knee infarction and auto-amputation of the right leg). Two of the 4 cases had hypereosinophilia that was probably induced by microfilaria. The mechanisms of mural thrombosis and thromboembolic infarcts in EMF cases are discussed, and the possibility shown that helminth induced eosinophilic myocarditis can induce similar acute mural thrombosis and thromboembolism. The place of anticoagulant therapy in EMF is discussed.
Keywords: Mural thrombi; thromboemboli; hypereosinophilic system
Résumé
La thrombose murale et le thromboembolisme sont plus communs au syndrome idiopathique hypereosinophiliques (HES), que la pathologie cardiaque que l’on ne peut distinguer de la fibrose endomyocardiale (EMF). Bien que les thromboses murales soient communes aux cas d’EMF, et les infractions emboliques post mortem sont fréquemment vu; la reconnaissance clinique du thromboembolisme aux EMF est rare. Nous reportons quatre cas de thromboembolisme Clinique parmi 106 cas consécutive de EMF (inclut un cas d’occlusion vasculaire subite et une infarction du genou inferieur et une auto-amputation du pied droit. Deux sur 4 cas avaient d’hyper éosinophilie qui était probablement induit par la microfilaire. Les mécanismes d’infarction thromboembolique et de thrombose murale aux cas de EMF sont discute, et la possibilité démontrait que les verres induisaient une myocardite eosinophilique semblable a la thrombose murale acute et thromboembolisme. La place thérapeutique des anticoagulants aux EMF est discute.
Correspondence: Prof. J.J. Andy, Department of Medicine, Faculty of Health Sciences, College of Health Sciences, University of Uyo, Uyo, Akwa Ibom State.
Erreferentziak
Shaper AG and Wright DH: Intracardiac Thrombosis and Embolism in Endomyocardial Fibrosis in Uganda. Brit Heart J. 1963, 25: 502-507
Ball JD, Williams AW, and Davies JNP. Endomyocardial Fibrosis. Lancet. 1949, 1:1049-1054
Davies JNP, and Ball JD. The Pathology of Endomyocardial Fibrosis in Uganda. Brit Heart J. 1955, 17: 337-359
Brockington IF and Olsen EGJ. Loffler’s Endocarditis and Davies Endomyocardial Fibrosis. Am Heart J. 1973, 85:305-322
Brockington IF, Olsen EGJ and Goodwin JF. Endomyocardial Fibrosis in European Residents in Tropical Africa. Lancet.1967, 1: 583-588
Ive FA, Willis JP, Ikeme AC, and Brockington IF. Endomyocardial Fibrosis and Filariasis. Q J Med. 1967, 36: 495-516
Andy JJ, Bishara FF and Soyinka OO. Relation of Severe Eosinophilia and Microfilariasis to Chronic African Endomyocardial Fibrosis. Brit Heart J. 1981, 45: 672-680
Andy JJ, Ogunowo PO, Akpan NA, Odigwe CO, Ekanem IA, and Esin RA. Helminth associated Hypereosinophilia and Tropical Endomyocardial Fibrosis. Acta Tropica. 1998, 69: 127-140
Gelfand M. Symmetrical Gangrene occurring in a female African affected with Endomyocardial Fibrosis. Cent Afr J Med. 1957, 3: 374-376
Davies JNP. Some Observations Regarding Obscure Disease affecting the Mural Endocardium. Am Heart J. 1960, 59: 600-618
Davies JNP: The Heart of Africa. Cardiac Pathology in the Population of Uganda. Lab Invest. 1961, 10: 205-212
Biljsma F. The Variety in Endomyocardial Fibrosis: A necropsy Study. Trop Geogr Med. 1976, 28:199-205
Mocumbi AO, Ferreira MB, Sidi D and Yacoub MH. A population study of Endomyocardial Fibrosis in a Rural Area of Mozambique. N Engl J Med. 2008, 359:43-49
Roberts WC, Leigler DG and Carbone PP. Endomyocardial Disease and Eosinophilia. Am J Med. 1969, 46: 28-42
Olsen EGJ. Morphologic Overview and Pathogenic Mechanisms in Endomyocardial Fibrosis associated with Eosinophilia . In: Olsen EGJ and Segikuchi M (Eds.), Cardiomyopathy Update 3. University of Tokyo Press, Tokyo, 1990, pp 1-8
Spry CJF. Eosinophilia and Endomyocardial Fibrosis. A Review of Clinical and Experimental Studies, 1980-1986. In: Cardiomyopathy Update 1, Kawai C and Abelman WH (eds.). 1986, 293-310. University of Tokyo Press, Tokyo
Andy JJ. Helminthiasis, the Hypereosinophilic Syndrome and Endomyocardial Fibosis: Some Observations and a Hypothesis. Afr J Med Sci. 1983, 12: 155-164
Andy JJ. The Relationship of Microfilaria and other Helminthic Worms to Tropical Endomyocardial Fibrosis. A Review. In: Cardiomyopathy Update 3 (Olsen E G & Sekiguchi M Eds.), 1990: 21-34. University of Tokyo Press.
Parry EHO and Abraham DG. The Natural History of Endomyocardial Fibrosis. Q J Med. 1965, 34: 383-408
Connor DH, Somers K, Hutt MSR, Manion WC, and D’Arbela PG. Endomyocardial Fibrosis in Uganda (Davies’ Disease) Parts I and II. Am Heart J. 1967, 74: 687-709 and 1968, 75: 107-124
Van Der Gel H, Peetom F, Somers K and Kanyarezi BR. Immunological and Serological Studies in Endomyocardial fibrosis. Lancet. 1966, 2:1210-1214
Andy JJ, O’Connell JP, Daddario RC, and Roberts WC. Trichinosis Causing Extensive Mural Endocarditis with Superimposed Thrombosis: Evidence that Severe Eosinophilia Damages Endomyocardium. Am J Med. 1977, 63: 824-829
Andy JJ, O’Connell JP, Daddario RC and Roberts WC. Trichinosis, Photomicrograph of Eosinophilic Myocarditis and Thrombosis. In: Hurst’s The Heart, 8th Edition, 1994; Colour Plate viii, no. 88-92
Kilduffe RA, Barbash SA and Merendino AG. A New Jersey Outbreak of Trichinosis with Report of a Case Complicated by Femoral Thrombosis Am J Med Sci. 1933, 186:794-802
Covey JA, McMahon JJ and Myers HL. Trichinosis as a Cause of Major Arterial Thrombosis. J Am Med Ass. 1949, 140:1212-1213
Spry CJF, Tai PC and Ogilvie BM. Hypereosinophilia in Rats with Trichinella spiralis Infection. Brit J Exp Path. 1980, 61: 1-7
Reiman HA, Price AH, and Herbut PA. Trichinosis and Periarteritis Nodosa. J Am Med Assoc. 1943, 122:274-282.
Spink WW. Cardiovascular Complications of Trichinosis. Arch Intern Med. 1935, 56:238-249
Andy JJ. Aetiology of Endomyocardial Fibrosis. West Afr Med J. 2001, 20:199-207
Cloetens W, de Mey D, Mahieux A and Solomentsev D. Ann Soc Belge Med Trop. 1959, 39: 799-805
Betrand–Fontaine SJ, Wolfrom R and Cagnard V. Un cas de filariose cerebrale (double hemiplegie) au cours d’une filariose a loa loa. Bull Mem Soc Med Hop Paris. 1948, 64: 1092-1095
Gerbaux A, Garin JP, and Lenegre J. Cardiopathie et filariose. Bull Mem Soc Med Hop Paris. 1957, 73: 873-887
Gardner-Thorpe C, Harriman DGF, Parsons M, and Rudge P. Loffler’s Eosinophilic Endocarditis with Balint’s Syndrome (Optic Ataxia and Paralysis of Visual Fixation). Q J Med. 1971, XL:249-260