Michael Kindermann1, Nitin Sood1, Peter Ehrlich1, Karin Klingel2. 1. Department of Cardiology, Angiology and Pneumology, CaritasKlinikum St. Theresia, Academic teaching hospital of the Saarland University Faculty of Medicine, Rheinstr. 2, 66113 Saarbrücken, Germany. 2. Department of Cardiopathology, Institute for Pathology, University Hospital Tübingen, Liebermeisterstr. 8, 72076 Tübingen, Germany.
Abstract
BACKGROUND: Eosinophilic myocarditis (EM) is rare but accounts for 12-22% of histologically proven acute myocarditis cases. Acute necrotizing EM is considered an aggressive, life-threatening disease which is usually treated by high-dose corticosteroid therapy. CASE SUMMARY: We report the case of a 27-year-old man with acute severe pericarditic chest pain, moderately reduced left ventricular (LV) ejection fraction, and a small pericardial effusion. Troponin I level was highly elevated in the absence of coronary artery disease, leading to the diagnosis of acute myopericarditis. In the absence of blood eosinophilia and despite a negative cardiac magnetic resonance study, LV endomyocardial biopsy revealed an acute necrotizing EM. With conventional antiphlogistic and heart failure therapy, the patient became symptom-free and inflammatory and cardiac necrosis markers as well as LV ejection fraction normalized within days. Thus, in the absence of a systemic hypereosinophilic disorder, there was no need for steroid therapy. Long-term follow-up over 12 months showed sustained normalization of cardiac structure and function. DISCUSSION: Acute necrotizing eosinophilic myopericarditis is not always a dreadful cardiac disease. There are idiopathic cases which may quickly resolve without immunosuppression. There seems to be a publication bias towards critical cases.
BACKGROUND: Eosinophilic myocarditis (EM) is rare but accounts for 12-22% of histologically proven acute myocarditis cases. Acute necrotizing EM is considered an aggressive, life-threatening disease which is usually treated by high-dose corticosteroid therapy. CASE SUMMARY: We report the case of a 27-year-old man with acute severe pericarditic chest pain, moderately reduced left ventricular (LV) ejection fraction, and a small pericardial effusion. Troponin I level was highly elevated in the absence of coronary artery disease, leading to the diagnosis of acute myopericarditis. In the absence of blood eosinophilia and despite a negative cardiac magnetic resonance study, LV endomyocardial biopsy revealed an acute necrotizing EM. With conventional antiphlogistic and heart failure therapy, the patient became symptom-free and inflammatory and cardiac necrosis markers as well as LV ejection fraction normalized within days. Thus, in the absence of a systemic hypereosinophilic disorder, there was no need for steroid therapy. Long-term follow-up over 12 months showed sustained normalization of cardiac structure and function. DISCUSSION: Acute necrotizing eosinophilic myopericarditis is not always a dreadful cardiac disease. There are idiopathic cases which may quickly resolve without immunosuppression. There seems to be a publication bias towards critical cases.
Authors: Michela Brambatti; Maria Vittoria Matassini; Eric D Adler; Karin Klingel; Paolo G Camici; Enrico Ammirati Journal: J Am Coll Cardiol Date: 2017-11-07 Impact factor: 24.094
Authors: Vanessa M Ferreira; Jeanette Schulz-Menger; Godtfred Holmvang; Christopher M Kramer; Iacopo Carbone; Udo Sechtem; Ingrid Kindermann; Matthias Gutberlet; Leslie T Cooper; Peter Liu; Matthias G Friedrich Journal: J Am Coll Cardiol Date: 2018-12-18 Impact factor: 24.094