Case report
An 8-year-old girl was admitted to our hospital in December 2019 complaining of rash for 11 days, abdominal pain for 8 days and fever, cough for 3 days. On physical examination, we found symmetrical distribution of dense reddish skin rash on limbs, ears and buttocks, no fading of pressure, slightly higher than skin, partially fused into pieces. Laboratory studies showed a white blood cell count of 14.83x109/L with 41.9%
eosinophils and an absolute value of 6.21×109/L (normal values,0.5%-5% or 0.05-3×109/L). A bone marrow biopsy showed marked eosinophilia with 42.5% but no evidence of abnormal myeloid maturation. Liver and kidney functions,troponin-I level, and creatinine kinase level were normal. Rheumatoid factor erythrocyte sedimentation rate, serum immunoglobulins and antinuclear antibodies were all within normal limits. The stool, urine and parasite analysis were normal. The X-ray of chest suggested pneumonia, abdominal ultrasound examination and transthoracic echocardiography showed normal. After 13 days of anti-infective and anti-eosinophils therapy, the white blood cell count of 16.83x109/L with 13.9% eosinophils and an absolute value of 1.58×109/L. the patient still had intermittent fever with higher temperature of up to 38.5 degree. Appeared of facial edema, anorexia, swelling of the liver. The X-ray of chest suggested aggravated pneumonia and pleural effusion. Transthoracic echocardiography revealed a large mass which nearly obliterated the right ventricular cavity and extended into the right ventricular outflow tract. The right atrium enlarged, moderate tricuspid regurgitation was noted, and moderate pericardial effusion was observed (Figure 1). So we did an emergency surgery for this patient. We operated via median sternotomy and under cardiopulmonary bypass. We found a large thrombus involving almost the entire right ventricle (Figure 2), the tricuspid was surrounded by the thrombus tissue seriously, then thrombectomy, tricuspid valvuloplasty were performed. The duration of extracorporeal circulation was 107 minutes and the aortic blockage duration was 82 minutes. The patient was extubated 10 hours after the operation in the Cardiac Care Unit(CCU) and no further complications. We used antibiotics to prevent infections, Using of furosemide and spironolactone to reduce cardiac load, used low-molecular-weight heparin calcium to prevent thrombus recurrence.
Histologic specimen showed thrombus, all of the pathological tissue were pink, degeneration, no structure, local rich in mucus with scattered and focal neutrophils, with a small number of small lymphocytes, eosinophils (HE staining, original magnification x10) (Figure 3).