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).