PMC9893995_01
MRI of the brain exhibiting multiple foci with hypersignal and diffusion restriction, suggestive of acute/subacute ischemia (red arrows).
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F1
After neurology evaluation, magnetic resonance imaging (MRI) of the brain was performed, which identified multiple diffuse hyperattenuating foci in the white matter, suggestive of ischemic involvement of cardioembolic origin (Fig. 1).
Cardiac MRI demonstrating thrombus-associated obliteration at the ventricular apices and diffuse subendocardial necrosis/fibrosis of both ventricles (red arrows).
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F2
The echocardiographic findings were confirmed by MRI and characteristic of eosinophilic endomyocardial fibrosis, often described in cases of Loeffler's endocarditis (Fig. 2).
Myelogram showing normocellular bone marrow, with hypercellularity of the eosinophilic cell line (Wright-Giemsa stain, magnification, x50).
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F3
The etiological hypotheses of hereditary or acquired thrombophilia, in addition to eosinophilic leukemia, were ruled out through laboratory exams and myelogram, which were all negative (Fig. 3).
Eosinophil count during hospitalization and treatment
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F4
He showed complete neurological recovery with improvement in headache and absence of focal deficits, in addition to a significant reduction in peripheral eosinophilia after 4 weeks (Fig. 4).