A Case of Acute Eosinophilic Myopericarditis Presenting with Cardiogenic Shock and Normal Peripheral Eosinophil Count

Abstract

Eosinophilic myocarditis usually results from myocardial damage as a result of drugs or parasites, and is generally associated with increased peripheral eosinophil count. This form of myocarditis is difficult to diagnose clinically.A 25 year-old previously healthy woman was transferred from a local clinic because of hypotension and dyspnea with sudden cardiogenic shock after a three day history of gastrointestinal illness. Echocardiography revealed concentric left ventricular wall thickening with moderate pericardial effusion. Biopsy of endomyocardial tissue from the right ventricle showed diffuse infiltration of inflammatory cells, mostly eosinophils, even though the patient had a peripheral eosinophil count that was normal at the time of biopsy. The patient was treated with corticosteroids for the symptoms of pericarditis, and she recovered without cardiac sequelae, clinically and echocardiographically. We here report a case of acute eosinophilic myopericarditis, with cardiogenic shock, diagnosed by endomyocardial biopsy with normal peripheral eosinophil count at the time of biopsy, and complete recovery without sequelae.

Hypersensitivity Myocarditis Presenting as Atrioventricular Block and Wide Complex Tachycardia in a Toddler

“…While rarely reported in pediatric patients 8–12 and largely in older children, eosinophilic myocarditis is well‐described in adults and occurs in Loffler's disease, vasculitic and granulomalous diseases (e.g., Churg‐Strauss syndrome), parasitic infections, and hypersensitivity reactions 13 . These conditions are usually associated with eosinophilia in the circulating peripheral blood; however, several reports have documented normal or only mildly increased eosinophil blood counts particularly associated with medication‐induced, biopsy‐confirmed eosinophilic myocarditis 14–16 . Our patient had been exposed to amoxicillin and zithromax, both of which have been associated with hypersensitivity reactions 3 .…”

“…13 These conditions are usually associated with eosinophilia in the circulating peripheral blood; however, several reports have documented normal or only mildly increased eosinophil blood counts particularly associated with medication-induced, biopsy-confirmed eosinophilic myocarditis. [14][15][16] Our patient had been exposed to amoxicillin and zithromax, both of which have been associated with hypersensitivity reactions. 3 Cold-like symptoms have also preceded the evolution of eosinophilic myocarditis in adult patients without a confirmed etiology.…”

Eosinophilic myocarditis: two case reports and review of the literature

“…In our second case presentation, the patient did not have a sustained level of peripheral eosinophilia during all of his medical encounters as such it remains unclear whether he had an undifferentiated form EM or HES. Similar case presentations of EM without significant levels of peripheral eosinophils have been documented in few cases across the medical literature [26-29]. The underlying mechanism of HES is postulated to be a primary disorder of myelopoiesis or an overproduction of eosinophilopoietic cytokines by lymphocytes [25].…”

Clinically suspected acute myopericarditis with cardiac tamponade associated with peripheral blood eosinophilia presenting in early pregnancy: a case report

“…The symptoms of eosinophilic myocarditis are akin to those of viral myocarditis. In the early stages of eosinophilic myocarditis, peripheral blood eosinophilia is sometimes absent [9]. Therefore, it is desirable to check the blood cell counts at intervals of 2 to 3 days when myocarditis is suspected.…”