Current Diagnostic and Therapeutic Aspects of Eosinophilic Myocarditis

Kuchynka, Petr; Paleček, Tomáš; Mašek, Martin; Černý, Vladimír; Lambert, Lukáš; Vítková, Ivana; Linhart, Aleš

doi:10.1155/2016/2829583

Cited by 79 publications

(146 citation statements)

References 25 publications

Supporting

Mentioning

141

Contrasting

Unclassified

Order By: Relevance

“…The most important cationic proteins are major basic protein, eosinophilic cationic protein, eosinophil-derived neurotoxin and eosinophilic peroxidase. These proteins can induce cellular apoptosis and necrosis when degranulation of eosinophils occurs 7. Eosinophils acquire IL-5 receptor α on their surface at the early stage during eosinophilopoiesis, differentiation and maturation, mainly under the influence of IL-5.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, CCR3 expressed in eosinophils will accumulate in cardiomyocytes, which leads to damage of heart tissue. Recent literature has indicated that eosinophilic infiltration and degranulation are associated with myocardial necrosis 7. Moreover, eosinophils bind to thrombomodulin, causing impaired formation of the thrombomodulin–thrombin complex.…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, eosinophils bind to thrombomodulin, causing impaired formation of the thrombomodulin–thrombin complex. Eosinophils also store tissue factor, which is the main anticoagulation factor, leading to a hypercoagulated state when eosinophils invade the heart 7. Furthermore, fibrosis has been observed in the endocardium.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Therapeutic effect of anti-IL-5 on eosinophilic myocarditis with large pericardial effusion

Song

Jones

Homsi³

2017

BMJ Case Reports

View full text Add to dashboard Cite

Eosinophilic myocarditis (EM) is a rare myocardial disease that results from various eosinophilic diseases, such as idiopathic hypereosinophilic syndrome, helminth infection, medications and vasculitis. Patients with EM may present with different severities, ranging from mild symptoms to a life-threatening condition. Diagnosis of EM is a challenge and requires an extensive workup, including endomyocardial biopsy. Treatment options are limited because EM is rare and there is a lack of randomised controlled trials. We report a case of EM that presented as cardiac tamponade, which was initially treated with high-dose prednisone and immunosuppressant medications without significant improvement. Mepolizumab (anti-interleukin (IL)-5 antibody) was then applied, leading to an increased ejection fraction and stabilised cardiac function. This case report shows, for the first time, that mepolizumab has novel effects in treating EM. Our findings suggest that mepolizumab can be used as a steroid-sparing agent for treating EM.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Therapeutic effect of anti-IL-5 on eosinophilic myocarditis with large pericardial effusion

Song

Jones

Homsi³

2017

BMJ Case Reports

View full text Add to dashboard Cite

show abstract

“…The diagnosis pathogenesis and treatment of the eosinophilic myocarditis was reviewed recently by Kuchynka et al, (12*). Although often associated with hypersensitivity responses to drugs and other allergens, many cases follow a viral infection.…”

Section: Introductionmentioning

confidence: 99%

Viral myocarditis

Rose¹

2016

Current Opinion in Rheumatology

128

103

View full text Add to dashboard Cite

Purpose of the review This article traces the pathways leading from viral infection of the heart by coxsackievirus B3 to autoimmune myocarditis in its various manifestations. Recent findings Myocarditis can be induced by a number of different infectious agents and represents a significant cause of death especially in young individuals. Following infection patients may develop lymphocytic, eosinophilic, or giant cell/granulomatous myocardial inflammation. It can lead to infectious dilated cardiomyopathy, a disease frequently requiring cardiac transplantation. Although acute viral myocarditis is frequently sub-clinical and recovery may be spontaneous, treatment of chronic myocarditis is presently unsatisfactory. Ongoing disease may be due to persistent virus in the heart or to immunopathic attack. Depending on the etiology, treatment may be antiviral or immunosuppressive. Endomyocardial biopsy is proving of value in determining etiology and deciding future therapy. A great deal of information about the pathogenesis of myocarditis has been gained from experimental models in rodents using heart disease induced by infection using coxsackievirus B3 or by immunization with cardiac myosin. Summary Treatment of myocarditis is still problematic and may depend on etiologic diagnosis to distinguish infectious from immune mediated disease. Both pathogenic mechanisms may co-occur in individual patients. In the future, treatment may depend upon endomyocardial biopsy, immunohistologic testing, improved imaging, and molecular genetic analysis for providing more precise diagnoses.

show abstract

“…The nonspecific signs are cardiac chest pain, dyspnea, fatigue, palpitations and syncope. Furthermore, allergic manifestation such as fever, rashes and blood eosinophilia may occur 5 . However, symptoms and signs of hypersensitivity are not present in all patients 6 .…”

mentioning

confidence: 99%