Eosinophilic Myocarditis: Clinical Case and Literature Review

Dinis, Paulo; Teixeira, Rogério; Puga, L; Lourenço, Carolina; Cachulo, Maria Carmo; Gonçalves, Lino

doi:10.5935/abc.20180089

Cited by 14 publications

(21 citation statements)

References 9 publications

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“…The patient had underlying asthma, which could be the source of hyper-eosinophilia and eosinophil deposition in the heart and lung, while withdrawal of steroids and hypersensitivity have also been reported as the source of EM in patients with asthma [ 19 – 21 ]. The increased LV wall thickness in the initial echocardiogram of our patient was most probably because of eosinophilic infiltration, which decreased and gradually normalized by the appropriate treatment (Table 2 ).…”

Section: Discussionmentioning

confidence: 99%

Evaluation of myocardial performance by serial speckle tracking echocardiography in diagnosis and follow-up of a patient with eosinophilic myocarditis

2023

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Background Speckle tracking echocardiography (STE) has been used as an adjunct diagnostic modality in patients with eosinophilic myocarditis. Its serial dynamic nature, however, has never been reported before. Case presentation A 17-year-old boy presented in cardiogenic shock state. His full blood count revealed an absolute eosinophilic count of 11.18 × 103/μL. An emergency 2D echocardiogram (2DE) showed global left ventricular hypokinesia with LVEF = 9.0% by Simpson’s method and a large amount of pericardial effusion. STE showed a global longitudinal strain (GLS) of − 4.1%. Because of his poor clinical status and presence of marked hypereosinophilia and the possibility of eosinophilic myocarditis (EM), parenteral pulse therapy with methylprednisolone and inotropes was started with subsequent improvement within the next 48 h. Over the next few days, he had his first cardiovascular magnetic resonance imaging (CMR), which showed late gadolinium enhancement (LGE) in different cardiac regions. After two weeks of therapy, he left the hospital in a stable condition, with LVEF = 38.0%, and GLS = − 13.9%. He did well during his two months of outpatient follow-ups and was found to have an absolute eosinophil count of 0.0% on several occasions. Unfortunately, he was re-admitted because of treatment non-compliance with almost the same, albeit milder, symptoms. The WBC count was 18.1 × 103 per microliter, and the eosinophilic count was 5.04 × 103/μL (28%). Heart failure treatment and high-dose prednisolone were started. After 15 days of admission, he got better and was discharged. During both hospital admissions and several months of follow-up, he had multiple 2DEs, STE, and two CMR studies. None of his STEs were identical to the prior studies and were dynamic with frequent wax and wanes throughout the admissions and follow-ups. Thus a single admission-time STE study was not sufficient enough to properly predict the patient’s outcome. Follow-up STEs showed new sites of myocardial involvement despite the absence of eosinophilia. Conclusion The use of STE in this patient, proved to have an added value in the evaluation and stratification of the left ventricular function in patients with EM and can be used as a diagnostic adjunct to CMR for diagnosis of EM.

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Section: Discussionmentioning

confidence: 99%

Evaluation of myocardial performance by serial speckle tracking echocardiography in diagnosis and follow-up of a patient with eosinophilic myocarditis

2023

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“…The severity of the cardiac disease depends on the degree of myocardial involvement. It ranges from a mild asymptomatic form to severe fulminant myocarditis or acute necrotizing eosinophilic myocarditis [ 1 ]. It can also present as a chronic process resulting in restrictive cardiomyopathy [ 2 ].…”

Section: Discussionmentioning

confidence: 99%

“…Eosinophilic myocarditis (EM) is a spectrum of myocardial diseases that can be acute or chronic. In its acute form, the patient may present with rapidly progressive necrotizing EM that is associated with a high mortality rate while the chronic form appears as restrictive cardiomyopathy with hypereosinophilic syndromes (HES) resulting in heart failure within a few years [ 1 - 2 ]. EM is most commonly reported in patients with hypersensitivity reactions; however, it has been also described in antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis, hypereosinophilic syndromes, sarcoidosis, parasitic infections, and certain neoplasms [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

Eosinophilic Myocarditis: A Challenging Diagnosis

Nassereddine¹,

Charif²,

Najjar³

et al. 2022

Cureus

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Eosinophilic myocarditis (EM) is a rare subtype of myocarditis that is characterized by eosinophilic infiltration of the myocardium and is associated with peripheral eosinophilia in most cases. The diagnosis is suspected in the presence of acute myocarditis and peripheral eosinophilia and is usually confirmed by endomyocardial biopsy (EMB) before starting steroid therapy. Here, we present a case of severe idiopathic eosinophilic myocarditis in a young man with a history of asthma and peripheral eosinophilia. He was treated with high-dose steroids despite negative EMB, and we noted a dramatic improvement in cardiac function. Our case highlights the importance of cardiac magnetic resonance (CMR) and clinical judgment in establishing the diagnosis of EM irrespective of the histopathologic result.

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“…Another similar reaction is eosinophilic myocarditis. The specific mechanism of cardiac damage caused by eosinophilic myocarditis is variable as well [ 106 ]. Some studies showed that eosinophil recruitment can cause direct damage to myocytes, but other studies suggest this may not be a consistent component of this condition [ 107 ].…”

Section: Vaccination-induced Autoimmunity and Myocarditismentioning

confidence: 99%

“…If untreated, continued cardiac dysfunction and chronic infection leads to fibrotic cardiac remodeling. The degree of remodeling can be correlated with cardiac fibrosis observed on cardiac magnetic resonance imaging (MRI) [ 106 , 161 , 162 ]. As remodeling progresses, dilated cardiomyopathy develops into heart failure as the myocardium becomes stiffer [ 204 , 205 ].…”

Section: Effects Of Myocarditis On the Heartmentioning

confidence: 99%

Comparison of COVID-19 Vaccine-Associated Myocarditis and Viral Myocarditis Pathology

et al. 2023

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The COVID-19 pandemic has led to significant loss of life and severe disability, justifying the expedited testing and approval of messenger RNA (mRNA) vaccines. While found to be safe and effective, there have been increasing reports of myocarditis after COVID-19 mRNA vaccine administration. The acute events have been severe enough to require admission to the intensive care unit in some, but most patients fully recover with only rare deaths reported. The pathways involved in the development of vaccine-associated myocarditis are highly dependent on the specific vaccine. COVID-19 vaccine-associated myocarditis is believed to be primarily caused by uncontrolled cytokine-mediated inflammation with possible genetic components in the interleukin-6 signaling pathway. There is also a potential autoimmune component via molecular mimicry. Many of these pathways are similar to those seen in viral myocarditis, indicating a common pathophysiology. There is concern for residual cardiac fibrosis and increased risk for the development of cardiomyopathies later in life. This is of particular interest for patients with congenital heart defects who are already at increased risk for fibrotic cardiomyopathies. Though the risk for vaccine-associated myocarditis is important to consider, the risk of viral myocarditis and other injury is far greater with COVID-19 infection. Considering these relative risks, it is still recommended that the general public receive vaccination against COVID-19, and it is particularly important for congenital heart defect patients to receive vaccination for COVID-19.

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Eosinophilic Myocarditis: Clinical Case and Literature Review

Cited by 14 publications

References 9 publications

Evaluation of myocardial performance by serial speckle tracking echocardiography in diagnosis and follow-up of a patient with eosinophilic myocarditis

Evaluation of myocardial performance by serial speckle tracking echocardiography in diagnosis and follow-up of a patient with eosinophilic myocarditis

Eosinophilic Myocarditis: A Challenging Diagnosis

Comparison of COVID-19 Vaccine-Associated Myocarditis and Viral Myocarditis Pathology

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