A case report of eosinophilic myocarditis and a review of the relevant literature

Abstract

BackgroundEosinophilic myocarditis (EM) is a relatively rare condition that may result from parasitic infections and allergic disease. Antituberculosis drugs may lead to focal myocardial infiltration by eosinophils (eosinophilic myocarditis). Symptoms may be severe, and, lead to rapidly-fatal outcomes. Early diagnosis and high-dose corticosteroids are the cornerstone of treatment, and, may lead to restoration of cardiac function with full recovery.Case presentationWe report a case of eosinophilic myocarditis secondary to eosinophilia caused by antituberculosis drugs with markedly elevated ECP, focal eosinophilic infiltration in CMR imaging and endomyocardial biopsy. Finally, high-dose corticosteroids were used to reverse the cardiac injury and to improve the clinical outcome.ConclusionAntituberculosis drugs can cause eosinophilic infiltration of, and damage to, the myocardium leading to rapid progression of the clinical symptoms. Myocardial biopsy is helpful in diagnosing the disease in the early stages and high-dose corticosteroids effectively improves the prognosis of this disease.

Sudden death in a pediatric heart transplant recipient with peripheral eosinophilia and eosinophilic myocardial infiltrates

“…4 Although not well established in the pathophysiology of rejection, eosinophils are known to degranulate within myocardial tissue, releasing cationic proteins that mediate myocardial tissue damage and local inflammation in eosinophilic myocarditis. 16 However, other authors have failed to demonstrate a relationship between eosinophil count and the risk of rejection, 17 and at least one study has suggested that elevated eosinophil count may be protective. 18 Additionally, there are parallels in terms of clinical and histopathologic findings between our case and HES.…”

Eosinophilic myocarditis: Gardia lamblia infestation and Garcinia cambogia. Coincidence or causality?

“…EM, a rare form of myocardial inflammation can be caused by various hypereosinohilic disorders, which include: -drug hypersensivity reactions (probably most common) [3] especially to antibiotics, antituberculotic drugs [7], anticonvulsants (carbamazepine) [8], anti-inflammatory, diuretics and inotropes (dobutamine) [9] and also antipsychotic clozapine [9,10] and toxins -parasitic infestations -toxocara canis [11,12], ascariasis [13], schistosomiasis, trichinosis, amoebiosis [6], toxoplasmosis [9] -idiopathic hypereosinophilic syndrome [9], -malignancies (T cell lymphoma, acute or chronic eosinophilic leukemia) [9,14] -paraneoplastic events (lung andenocarcinoma [15] or biliary tract cancers [9] -vasculitic and granulomatous disease (Churg -Strauss syndrome) [6,9] -tropical endomyocardial disease [6] -transplant rejections [6] In the case described above two possible aetiologies of EM might be suspected, which are Giardia lamblia infestation and Garcinia cambogia supplements admission prior to the hospitalization. The active agent of Garcinia cambodia is hydroxycitric acid, which plays a role in the inhibition of fatty acids synthesis.…”

A case of eosinophilic myocarditis

“…[4][5][6] The decision was made to not add an immunosuppressive agent to their treatment regimen, as the offending drug agent had been removed, and it was theorized that it would likely not add any benefit. Patient improved clinically on corticosteroids and with removal of the offending drug agent.…”

“…[4] Other case reports have documented high dose corticosteroids followed by a taper which have resulted in complete resolution of the disease. [5] Doses of steroids utilized in clinical care can be varied, but often courses of treatment are initiated with methylprednisolone regimen of 1 mg/kg/day, followed by a taper with varying durations. [4][5][6] Depending on the severity of the disease, high dose pulse therapy for up to three days is often included in the treatment regimen for those presenting in cardiogenic shock, later followed by starting 1 mg/kg/day regimen.…”

“…[5] Doses of steroids utilized in clinical care can be varied, but often courses of treatment are initiated with methylprednisolone regimen of 1 mg/kg/day, followed by a taper with varying durations. [4][5][6] Depending on the severity of the disease, high dose pulse therapy for up to three days is often included in the treatment regimen for those presenting in cardiogenic shock, later followed by starting 1 mg/kg/day regimen. [6] It is unclear what the optimal dose, duration, or taper administration of corticosteroids is needed to optimize cure rates, and prevent disease remission.…”