Therapeutic Role of Pericardiocentesis for Acute Necrotizing Eosinophilic Myocarditis With Cardiac Tamponade

Kazama, Ryu; Okura, Yuji; Hoyano, Makoto; Toba, Kenji; Ochiai, Yoshie; Ishihara, Noriko; Kobayashi, Takashi; Yoshida, Tsuyoshi; Namura, Osamu; Sogawa, Masakazu; Nakamura, Yūichi; Yoshimura, Nobuhiko; Nishikura, Ken; Kato, Kiminori; Hanawa, Haruo; Tamura, Yusuke; Morimoto, Shin-ichiro; Kodama, Makoto; Aizawa, Yoshifusa

doi:10.4065/78.7.901

Cited by 26 publications

(19 citation statements)

References 16 publications

(14 reference statements)

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“…4) Also, some reports have shown that conventional management strategies without corticosteroid therapy could improve the acute and chronic phases of EM. 5,6) …”

Section: Discussionmentioning

confidence: 99%

“…Also, it was reported that a patient with acute necrotizing eosinophilic myocarditis rapidly recovered without corticosteroid therapy. 5) Ishide, et al reported 25 Japanese cases of EM, 2 of whom improved without corticosteroid therapy. 8) In spite of the lack of definite evidence regarding the effectiveness of corticosteroid therapy, we have "believed" that the early administration of corticosteroids is necessary.…”

mentioning

confidence: 99%

“…4) Also, some reports have shown that conventional management strategies without corticosteroid therapy could improve the acute and chronic phases of EM. 5,6) Thus, it remains controversial as to whether all patients with EM should be treated with corticosteroids. The present study was conducted to clarify the clinical significance of corticosteroid therapy for EM.…”

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confidence: 99%

“…Recently, there have been some reports that various cytokines, such as soluble-intercellular adhesion molecule-1, IL-3, IL-4, IL-5, IL-13, and TGF-β1play important roles in the proliferation, differentiation, and migration of eosinophils, and in IgE synthesis. 5,12) Among these, IL-5 has been implicated as playing a key role in the pathogenesis of myocarditis in the active phase. IL-5 produced in heart tissue recruits circulating eosinophils into the perivascular area of the heart through transmigration, and stimulates eosinophilopoiesis in bone marrow.…”

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confidence: 99%

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Clinical Significance of Corticosteroid Therapy for Eosinophilic Myocarditis

et al. 2011

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SummaryThe recommended treatment for eosinophilic myocarditis (EM), pathologically defined as myocardial inflammation with eosinophil infiltration, is corticosteroids. Although EM has a wide variety of clinical features including the degree of eosinophilic infiltration, there have been no reports on how patients with EM should be treated with corticosteroids irrespective of their pathological findings.Thirty-seven consecutive patients with acute myocarditis hospitalized in our institute between 1996-2009 were enrolled. Excluding those with secondary EM such as Loeffler's endocarditis, hypereosinophilic syndrome, and ChurgStrauss Syndrome, together with drug-induced allergic myocarditis, the subjects were divided into 2 groups according to the existence of eosinophils in the myocardial interstitium observed in endomyocardial biopsy specimens. There were no differences in the clinical characteristics on admission between the 2 groups: with (group EM, n = 22) and without (group lymphocytic myocarditis (LM), n = 7) eosinophilic infiltrates irrespective of pathological differences. The treatment policy has been consistent in our institution: intensive hemodynamic observation and support without corticosteroid administration, not only in LM but also in idiopathic EM. There was no significant difference in clinical recovery in the acute phase as indicated by the hospitalization period, left ventricular ejection fraction, or long-term prognosis in EM compared to LM.A conventional management strategy for idiopathic EM without corticosteroid administration can improve the prognosis in the acute and chronic phases, similar to that of LM. (Int Heart J 2011; 52: 110-113) Key words: Eosinophilic myocarditis, Endomyocardial biopsy, Corticosteroid therapy E osinophilic myocarditis (EM) is a relatively rare condition. Although the etiology of EM is not always apparent, several causes have been identified, including hypersensitivity to medicine or some other substance with the heart as the target organ. The spectrum of clinical presentation is wide, and EM is likely to lead to progressive myocardial damage with destruction of the conduction system and then refractory heart failure. It is widely known that EM demonstrates cardiac symptoms with pathological findings of infiltration of eosinophils and degranulation in the myocardium. It has been recommended EM be treated with corticosteroid therapy, according to the guidelines 1) but such is not the case regarding viral myocarditis. In previous reports, some cases of EM, including those with a history of severe left ventricle (LV) dysfunction and aborted sudden death, showed dramatic responses to corticosteroid therapy.2,3) In one case report, an intravenous bolus of methylprednisolone (1 g/day for three days) followed by 1 mg/kg/day oral prednisolone with gradual tapering for one year resulted in an improvement of symptoms, a reduction in the eosinophil count, and increased LV ejection fraction as shown by echocardiography. 4) Also, some reports have shown that conventional managem...

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“…4) Also, some reports have shown that conventional management strategies without corticosteroid therapy could improve the acute and chronic phases of EM. 5,6) …”

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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confidence: 99%

mentioning

confidence: 99%

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Clinical Significance of Corticosteroid Therapy for Eosinophilic Myocarditis

et al. 2011

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“…In other medical fields not related to the perinatal period, there have been some reports on cytokines related to pericardial effusion (Shikama et al 2000;Kazama et al 2003). Shikama et al (2000) reported a case of rheumatoid pericarditis with cardiac tamponade.…”

Section: Discussionmentioning

confidence: 99%

Cytokine Profiles in Pericardial Effusion in a Down Syndrome Infant with Transient Abnormal Myelopoiesis

Shitara

Takahashi

Aoki

et al. 2017

Tohoku J. Exp. Med.

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Infants with Down Syndrome (DS) are at risk of developing a transient abnormal myelopoiesis (TAM). TAM is characterised by increased circulating blast cells but usually self-limiting. DS patients with TAM sometimes show fetal hydrops and effusion in body cavities, but the mechanism remains unclear. We report here a case of infant with DS who had pericardial effusion, TAM, and eosinophilia. In her pericardial effusion, white blood cell count was 6.0 × 10 3 /µL, 41% of which were eosinophils. After administration of prednisolone, pericardial effusion gradually decreased, and TAM and eosinophilia improved. In order to elucidate the immunological mechanism, we measured the levels of 17 cytokines in her pericardial effusion fluid and serum. In her pericardial fluid, there were high levels of 12 cytokines, and they were higher than those in her serum. In particular, IL-6 (44,573 pg/mL), IL-8 (4,865 pg/mL), and IL-13 (579.41 pg/mL) were at extremely high levels in her pericardial fluid. After administration of prednisolone, the levels of 8 of the 12 elevated cytokines in her pericardial fluid decreased and all of the elevated cytokines decreased in her serum. Corticosteroids can be effective to reduce cytokine levels and the amount of effusion in patients with DS. It is presumed that effusion seen in DS with TAM could be related to an abnormal production of cytokines at the effusion site.

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Neutralization of Th2 Cytokines in Therapy of Cardiovascular Pathology

Mandel¹,

Bolton²

2007

Immune Dysfunction and Immunotherapy in Heart Disease

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Therapeutic Role of Pericardiocentesis for Acute Necrotizing Eosinophilic Myocarditis With Cardiac Tamponade

Cited by 26 publications

References 16 publications

Clinical Significance of Corticosteroid Therapy for Eosinophilic Myocarditis

Clinical Significance of Corticosteroid Therapy for Eosinophilic Myocarditis

Cytokine Profiles in Pericardial Effusion in a Down Syndrome Infant with Transient Abnormal Myelopoiesis

Neutralization of Th2 Cytokines in Therapy of Cardiovascular Pathology

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