Volume 155, Issue 5, Pages e149-e154 (May 2019)

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Volume 155, Issue 5, Pages e149-e154 (May 2019) A 45-Year-Old Man With Progressive Dyspnea, Chest Pain, and Hypereosinophilia Juan F. Bulnes, MD, Martín Lasso, MD, Miguel A. Díaz, MD, Vicente Sandoval, MD, Pablo Varas, MD, Rodrigo Saavedra, MD, Mauricio García, MD, Felipe Guzman, MD, Raquel Rocha, MD CHEST Volume 155, Issue 5, Pages e149-e154 (May 2019) DOI: 10.1016/j.chest.2018.12.019 Copyright © 2019 American College of Chest Physicians Terms and Conditions

Figure 1 ECG obtained at admission, showing Q wave and ST segment elevation in III, slight concave ST elevation in V2-4, and ST depression in I, aVL, and V6. CHEST 2019 155, e149-e154DOI: (10.1016/j.chest.2018.12.019) Copyright © 2019 American College of Chest Physicians Terms and Conditions

Figure 2 Chest radiograph showing diffuse bilateral opacities and mild right-sided pleural effusion. CHEST 2019 155, e149-e154DOI: (10.1016/j.chest.2018.12.019) Copyright © 2019 American College of Chest Physicians Terms and Conditions

Figure 3 A, B, Transthoracic echocardiographic views obtained at admission in (A) parasternal short-axis view and (B) apical four-chamber view, revealing severely thickened left ventricular wall (because of myocardial edema and tissue infiltration), reduced left ventricular cavity size, and severe pericardial effusion (asterisk) (Video 1). CHEST 2019 155, e149-e154DOI: (10.1016/j.chest.2018.12.019) Copyright © 2019 American College of Chest Physicians Terms and Conditions

Figure 4 Treatment-induced changes in LVEF and peripheral eosinophil count. After initiation of corticosteroids, LVEF improved and peripheral eosinophil count decreased to zero. With corticosteroid tapering, LVEF worsened and eosinophilia reappeared, with rapid improvement after the corticosteroid dose was increased again. Corticosteroids were safely tapered when treatment with albendazole was completed. Corticosteroid dose is expressed as methylprednisolone equivalent. Eo = peripheral eosinophil count; LVEF= left ventricular ejection fraction. CHEST 2019 155, e149-e154DOI: (10.1016/j.chest.2018.12.019) Copyright © 2019 American College of Chest Physicians Terms and Conditions