Hypereosinophilic Syndrome Presented With Myocardial Infarction With Non-Obstructive Coronary Arteries: A Case Report



Haji Zeinali A M ; Bekravi M
Source: Journal of Advances in Medical and Biomedical Research Published:2026

Abstract

Hypereosinophilic syndrome (HES) is characterized by persistent eosinophilia without any discernible underlying cause. The patient may exhibit no symptoms or may present with a disorder affecting multiple systems. Electrocardiography, echocardiography, and cardiac magnetic resonance imaging are commonly used methods to assess cardiac involvement in HES. Recognizing HES early can be difficult since the initial stage typically lacks noticeable clinical symptoms. Here, we report a 45-year-old man with HES that mimics the signs and symptoms of acute coronary syndrome. After ruling out other possible diagnoses, Electrocardiography revealed inverted T-waves in pericardial leads (V4–V6). Coronary angiography demonstrated non-obstructive coronary artery disease. Echocardiography showed moderate left ventricular (LV) hypertrophy, a lobulated apical LV mass, trivial tricuspid regurgitation, and mild pleural effusion. Cardiac MRI identified an apical LV mass with iso/high signal intensity on STIR sequences and no enhancement on late gadolinium enhancement (LGE), consistent with LV thrombus in the setting of HES. On admission, troponin level was 869 ng/ml. HES was confirmed, and the patient was treated with prednisolone (5 mg/kg daily) and apixaban (10 mg BID for 7 days, then 5 mg BID). Follow-up demonstrated a decrease in troponin to 351 ng/ml and complete resolution of the LV thrombus on echocardiography. © 2026 Farname Inc.. All rights reserved.