{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T15:59:12Z","timestamp":1791907152952,"version":"4.3.4"},"reference-count":36,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2023,5,19]],"date-time":"2023-05-19T00:00:00Z","timestamp":1684454400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, Romania","award":["615\/13\/17.01.2019"],"award-info":[{"award-number":["615\/13\/17.01.2019"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>The presence of the Fip1-Like1-platelet-derived growth factor receptor alpha (FIP1L1\u2013PDGFR\u03b1) fusion gene represents a rare cause of hypereosinophilic syndrome (HES), which is associated with organ damage. The aim of this paper is to emphasize the pivotal role of multimodal diagnostic tools in the accurate diagnosis and management of heart failure (HF) associated with HES. We present the case of a young male patient who was admitted with clinical features of congestive HF and laboratory findings of hypereosinophilia (HE). After hematological evaluation, genetic tests, and ruling out reactive causes of HE, a diagnosis of positive FIP1L1\u2013PDGFR\u03b1 myeloid leukemia was established. Multimodal cardiac imaging identified biventricular thrombi and cardiac impairment, thereby raising suspicion of Loeffler endocarditis (LE) as the cause of HF; this was later confirmed by a pathological examination. Despite hematological improvement under corticosteroid and imatinib therapy, anticoagulant, and patient-oriented HF treatment, there was further clinical progression and subsequent multiple complications (including embolization), which led to patient death. HF is a severe complication that diminishes the demonstrated effectiveness of imatinib in the advanced phases of Loeffler endocarditis. Therefore, the need for an accurate identification of heart failure etiology in the absence of endomyocardial biopsy is particularly important for ensuring effective treatment.<\/jats:p>","DOI":"10.3390\/diagnostics13101795","type":"journal-article","created":{"date-parts":[[2023,5,19]],"date-time":"2023-05-19T09:23:10Z","timestamp":1684488190000},"page":"1795","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["FIP1L1\u2013PDGFR\u03b1-Positive Loeffler Endocarditis\u2014A Distinct Cause of Heart Failure in a Young Male: The Role of Multimodal Diagnostic Tools"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6395-9476","authenticated-orcid":false,"given":"Andreea","family":"Varga","sequence":"first","affiliation":[{"name":"Department ME2-Clinical Disciplines, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540142 Targu Mures, Romania"},{"name":"Department of Internal Medicine II-Cardiology, Emergency Clinical County Hospital, 540042 Targu Mures, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-5536-3938","authenticated-orcid":false,"given":"Diana Andreea","family":"Moldovan","sequence":"additional","affiliation":[{"name":"Department of Cardiology I, The Emergency Institute for Cardiovascular Diseases and Transplantation, 540136 Targu Mures, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5324-9780","authenticated-orcid":false,"given":"Marian","family":"Pop","sequence":"additional","affiliation":[{"name":"Department ME1-Preclinical Disciplines, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540142 Targu Mures, Romania"},{"name":"Department of Radiology and Medical Imaging, The Emergency Institute for Cardiovascular Diseases and Transplantation, 540136 Targu Mures, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Istvan","family":"Benedek","sequence":"additional","affiliation":[{"name":"Department of Family Medicine, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540142 Targu Mures, Romania"},{"name":"Department of Hematology II, Emergency Clinical County Hospital, 540042 Targu Mures, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Attila","family":"K\u00f6vecsi","sequence":"additional","affiliation":[{"name":"Department of Pathology, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540142 Targu Mures, Romania"},{"name":"Department of Pathology, Emergency Clinical County Hospital, 540136 Targu Mures, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert Adrian","family":"Dumbrava","sequence":"additional","affiliation":[{"name":"Doctoral School, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540142 Targu Mures, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dragos Gabriel","family":"Iancu","sequence":"additional","affiliation":[{"name":"Doctoral School, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540142 Targu Mures, Romania"},{"name":"Department of Internal Medicine VIII, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540142 Targu Mures, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liviu","family":"Cristescu","sequence":"additional","affiliation":[{"name":"Doctoral School, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540142 Targu Mures, Romania"},{"name":"Department of Internal Medicine VIII, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540142 Targu Mures, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9413-7803","authenticated-orcid":false,"given":"Laurentiu","family":"Huma","sequence":"additional","affiliation":[{"name":"Department of Cardiology I, The Emergency Institute for Cardiovascular Diseases and Transplantation, 540136 Targu Mures, Romania"},{"name":"Doctoral School, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540142 Targu Mures, Romania"},{"name":"Department of Cellular and Molecular Biology, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540142 Targu Mures, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3828-1499","authenticated-orcid":false,"given":"Ioan","family":"Tilea","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine II-Cardiology, Emergency Clinical County Hospital, 540042 Targu Mures, Romania"},{"name":"Department of Internal Medicine VIII, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540142 Targu Mures, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,5,19]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"607","DOI":"10.1016\/j.jaci.2012.02.019","article-title":"Contemporary consensus proposal on criteria and classification of eosinophilic disorders and related syndromes","volume":"130","author":"Valent","year":"2012","journal-title":"J. Allergy Clin. Immunol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1002\/ajh.26352","article-title":"World Health Organization-defined eosinophilic disorders: 2022 update on diagnosis, risk stratification, and management","volume":"97","author":"Shomali","year":"2022","journal-title":"Am. J. Hematol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"423","DOI":"10.1007\/s00281-021-00863-y","article-title":"Eosinophils and eosinophil-associated disorders: Immunological, clinical, and molecular complexity","volume":"43","author":"Valent","year":"2021","journal-title":"Semin. Immunopathol."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Lupu, S., Pop, M., and Mitre, A. (2022). Loeffler Endocarditis Causing Heart Failure with Preserved Ejection Fraction (HFpEF): Characteristic Images and Diagnostic Pathway. Diagnostics, 12.","DOI":"10.3390\/diagnostics12092157"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"2125","DOI":"10.1016\/j.jaip.2022.03.034","article-title":"Clinical Profile and Treatment in Hypereosinophilic Syndrome Variants: A Pragmatic Review","volume":"10","author":"Requena","year":"2022","journal-title":"J. Allergy Clin. Immunol. Pract."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"74","DOI":"10.1016\/j.case.2019.10.008","article-title":"Loeffler Endocarditis: A Manifestation of Hypereosinophilic Syndrome","volume":"4","author":"Arustamyan","year":"2019","journal-title":"CASE"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"305","DOI":"10.1093\/ajcp\/aqaa056","article-title":"Contemporary Classification and Diagnostic Evaluation of Hypereosinophilia","volume":"154","author":"Mattis","year":"2020","journal-title":"Am. J. Clin. Pathol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"e1","DOI":"10.1097\/MD.0b013e3182a71eba","article-title":"The Spectrum of FIP1L1-PDGFRA-Associated Chronic Eosinophilic Leukemia: New Insights Based on a Survey of 44 Cases","volume":"92","author":"Legrand","year":"2013","journal-title":"Medicine"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"33229","DOI":"10.18632\/oncotarget.8906","article-title":"Long-term outcomes of imatinib in patients with FIP1L1\/PDGFRA associated chronic eosinophilic leukemia: Experience of a single center in China","volume":"7","author":"Qu","year":"2016","journal-title":"Oncotarget"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"553","DOI":"10.1111\/bjh.14488","article-title":"Guideline for the investigation and management of eosinophilia","volume":"176","author":"Butt","year":"2017","journal-title":"Br. J. Haematol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1999","DOI":"10.1038\/leu.2008.287","article-title":"Five years since the discovery of FIP1L1-PDGFRA: What we have learned about the fusion and other molecularly defined eosinophilias","volume":"22","author":"Gotlib","year":"2008","journal-title":"Leukemia"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"3759","DOI":"10.1158\/0008-5472.CAN-06-4183","article-title":"Molecular mechanisms underlying FIP1L1-PDGFRA-mediated myeloproliferation","volume":"67","author":"Buitenhuis","year":"2007","journal-title":"Cancer Res."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1314","DOI":"10.1002\/ajh.25945","article-title":"Epidemiology, clinical picture and long-term outcomes of FIP1L1-PDGFRA-positive myeloid neoplasm with eosinophilia: Data from 151 patients","volume":"95","author":"Rohmer","year":"2020","journal-title":"Am. J. Hematol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"158","DOI":"10.4065\/mcp.2009.0503","article-title":"Hypereosinophilic syndrome and clonal eosinophilia: Point-of-care diagnostic algorithm and treatment update","volume":"85","author":"Tefferi","year":"2010","journal-title":"Mayo Clin. Proc."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1159\/000489341","article-title":"The Diagnostic Work-Up of Hypereosinophilia","volume":"86","author":"Wang","year":"2019","journal-title":"Pathobiology"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"967","DOI":"10.1007\/s00280-011-1582-3","article-title":"Durable remission after treatment with very low doses of imatinib for FIP1L1-PDGFR\u03b1-positive chronic eosinophilic leukaemia","volume":"67","author":"Helbig","year":"2011","journal-title":"Cancer Chemother. Pharmacol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"100118","DOI":"10.1016\/j.jtauto.2021.100118","article-title":"Diagnosis and treatment of eosinophilic myocarditis","volume":"4","author":"Zhong","year":"2021","journal-title":"J. Transl. Autoimmun."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"100","DOI":"10.4250\/jcu.2015.23.2.100","article-title":"A Hypereosinophilic Syndrome with Cardiac Involvement from Thrombotic Stage to Fibrotic Stage","volume":"23","author":"Kim","year":"2015","journal-title":"J. Cardiovasc. Ultrasound."},{"key":"ref_19","first-page":"2359532","article-title":"Hypereosinophilic Syndrome: A Case of Fatal L\u00f6ffler Endocarditis","volume":"2016","author":"Ortega","year":"2016","journal-title":"Case Rep. Cardiol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1427","DOI":"10.1016\/j.echo.2020.09.002","article-title":"Loeffler\u2019s Endocarditis: An Integrated Multimodality Approach","volume":"33","author":"Polito","year":"2020","journal-title":"J. Am. Soc. Echocardiogr."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"I123","DOI":"10.1093\/eurheartjsupp\/suac085","article-title":"Clinical implications of cardiac magnetic resonance imaging fibrosis","volume":"24","author":"Guglielmo","year":"2022","journal-title":"Eur. Heart J. Suppl."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"100","DOI":"10.1136\/heartjnl-2015-307959","article-title":"Hypereosinophilic syndrome: Cardiac diagnosis and management","volume":"102","author":"Mankad","year":"2016","journal-title":"Heart"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1179547617723643","DOI":"10.1177\/1179547617723643","article-title":"Loeffler Endocarditis: A Unique Presentation of Right-Sided Heart Failure Due to Eosinophil-Induced Endomyocardial Fibrosis","volume":"10","author":"Alam","year":"2017","journal-title":"Clin. Med. Insights Case Rep."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"E57","DOI":"10.1111\/j.1540-8175.2009.01144.x","article-title":"Hypereosinophilic syndrome presenting with biventricular cardiac thrombi","volume":"27","author":"Lodha","year":"2010","journal-title":"Echocardiography"},{"key":"ref_25","first-page":"e10061","article-title":"Loeffler\u2019s Endocarditis and the Diagnostic Utility of Multimodality Imaging","volume":"12","author":"Afzal","year":"2020","journal-title":"Cureus"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1319","DOI":"10.1016\/j.jaci.2009.09.022","article-title":"Hypereosinophilic syndrome: A multicenter, retrospective analysis of clinical characteristics and response to therapy","volume":"124","author":"Ogbogu","year":"2009","journal-title":"J. Allergy Clin. Immunol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"e0079","DOI":"10.1097\/MD.0000000000010079","article-title":"Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature","volume":"97","author":"Gao","year":"2018","journal-title":"Medicine"},{"key":"ref_28","first-page":"255","article-title":"Exquisite response to imatinib mesylate in FIP1L1-PDGFRA-mutated hypereosinophilic syndrome: A 12-year experience of the Polish Hypereosinophilic Syndrome Study Group","volume":"130","author":"Helbig","year":"2020","journal-title":"Pol. Arch. Intern. Med."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"3552","DOI":"10.1182\/blood-2007-07-100164","article-title":"Relapse following discontinuation of imatinib mesylate therapy for FIP1L1\/PDGFRA-positive chronic eosinophilic leukemia: Implications for optimal dosing","volume":"110","author":"Klion","year":"2007","journal-title":"Blood"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1214","DOI":"10.1002\/ajh.25842","article-title":"A myeloid neoplasm with FIP1L1-PDGFRA presenting as acute myeloid leukemia","volume":"94","author":"Cadenas","year":"2020","journal-title":"Am. J. Hematol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"320","DOI":"10.1007\/s12185-012-1141-7","article-title":"Response to imatinib mesylate in patients with hypereosinophilic syndrome","volume":"96","author":"Arefi","year":"2012","journal-title":"Int. J. Hematol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"2879","DOI":"10.1182\/blood-2003-06-1824","article-title":"The FIP1L1-PDGFRalpha fusion tyrosine kinase in hypereosinophilic syndrome and chronic eosinophilic leukemia: Implications for diagnosis, classification, and management","volume":"103","author":"Gotlib","year":"2004","journal-title":"Blood"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"837","DOI":"10.1016\/j.leukres.2008.10.004","article-title":"Imatinib has limited therapeutic activity for hypereosinophilic syndrome patients with unknown or negative PDGFRalpha mutation status","volume":"33","author":"Jain","year":"2009","journal-title":"Leuk. Res."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"56","DOI":"10.4274\/Tjh.2013.0086","article-title":"FIP1L1-PDGFRA-Positive Chronic Eosinophilic Leukemia: A Low-Burden Disease with Dramatic Response to Imatinib\u2014A Report of 5 Cases from South India","volume":"31","author":"Kumar","year":"2014","journal-title":"Turk. J. Haematol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"688.e5","DOI":"10.1016\/j.cjca.2017.01.006","article-title":"Hypereosinophilic Syndrome as a Rare Cause of Reversible Biventricular Heart Failure","volume":"33","author":"Bonou","year":"2017","journal-title":"Can. J. Cardiol."},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Zhang, Q., Si, D., Zhang, Z., and Zhang, W. (2021). Loeffler endocarditis with intracardiac thrombus: Case report and literature review. BMC Cardiovasc. Disord., 21.","DOI":"10.1186\/s12872-021-02443-2"}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/13\/10\/1795\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T19:38:14Z","timestamp":1760125094000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/13\/10\/1795"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,5,19]]},"references-count":36,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2023,5]]}},"alternative-id":["diagnostics13101795"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics13101795","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,5,19]]}}}