Infiltrating a Traveler's Heart: A Unique Presentation of Acute Heart Failure

Ewart, Dave; García, Santiago; Peltola, Justin; Vakil, Kairav

doi:10.1016/j.amjmed.2016.03.040

Cited by 2 publications

(3 citation statements)

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“…In fact, we have not found a comprehensive review of cardiac manifestations or histopathologic findings specifically in patients with diagnosed DS. In 2017, Brambatti et al [50] published a comprehensive systematic review of 179 histologically proven EM cases, finding that EM was associated with hypersensitivity in 61 patients, out of which only 10 cases fulfilled criteria for DS [19,22,24,26,33,35,36,38,41,46].…”

Section: Discussionmentioning

confidence: 99%

“…Cardiac MRI was obtained in only five patients (11.9%), two of them showing no changes [22,37], but three cases showed either delayed enhancement pattern or hyperenhancement, mainly of the sub-pericardium and mid-myocardium, which are suggestive of acute myocarditis [11,15,25]. We found that in 22 cases (52.4%) that had EMB or an autopsy done, histopathologic analysis showed significant EM (including Acute necrotizing EM (ANEM)), predominance over GCM (67.4% vs. 18.2%), and in only 2 cases (9.1%) there were microscopic findings consistent with a combination of EM and GCM [20,35].…”

Section: Cardiac Evaluationmentioning

confidence: 99%

“…Histopathologically, myocarditis in DS manifests mostly as EM or GCM based on case reports in which biopsy was done [10,11,15,17,[19][20][21][22]24,26,[30][31][32][33]35,38,41,[45][46][47][48]. EM is a rare form of myocardial inflammation characterized by an abundant eosinophilic infiltrate.…”

Section: Dress Myocarditis Histopathologymentioning

confidence: 99%

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“Heart in DRESS”: Cardiac Manifestations, Treatment and Outcome of Patients with Drug Reaction with Eosinophilia and Systemic Symptoms Syndrome: A Systematic Review

Radovanovic

Jevtic

Calvin

et al. 2022

JCM

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Cardiac involvement in drug reaction with eosinophilia and systemic symptoms (DS) is rare but associated with high mortality. The aim of this research was to systematically review case reports by PRISMA guidelines in order to synthetize the knowledge of cardiac manifestations of DS. We identified 42 cases from 36 case reports. Women were two times more affected than men. Two-thirds of patients had cardiac manifestation in the initial phase of the disease, while in one-third of cases cardiac manifestations developed later (mean time of 70 ± 63 days). The most common inciting medications were minocycline (19%) and allopurinol (12%). In 17% of patients, the heart was the only internal organ affected, while the majority (83%) had at least one additional organ involved, most commonly the liver and the kidneys. Dyspnea (55%), cardiogenic shock (43%), chest pain (38%), and tachycardia (33%) were the most common cardiac signs and symptoms reported. Patients frequently had an abnormal ECG (71.4%), and a decrease in left ventricular ejection fraction was the most common echocardiographic finding (45%). Endomyocardial biopsy or histological examination at autopsy was performed in 52.4%, with the predominant finding being fulminant eosinophilic myocarditis with acute necrosis in 70% of those biopsied. All patients received immunosuppressive therapy with intravenous steroids, while non-responders were more likely to have received IVIG, cyclosporine, mycophenolate, and other steroid-sparing agents (60%). Gender and degree of left ventricular systolic dysfunction were not associated with outcomes, but short latency between drug exposure and the first DRESS symptom onset (<15 days) and older age (above 65 years) was associated with death. This underscores the potential importance of heightened awareness and early treatment.

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