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Review
. 2006 Dec;22(14):1233-7.
doi: 10.1016/s0828-282x(06)70965-5.

Eosinophilic myocarditis: case series and review of literature

Abdullah M Al Ali  1 , Lynn P Straatman, Michael F Allard, Andrew P Ignaszewski
Affiliations
Review

Eosinophilic myocarditis: case series and review of literature

Abdullah M Al Ali et al. Can J Cardiol. 2006 Dec.

Abstract
in English, French

Although the etiology of eosinophilic myocarditis (EM) is not always apparent, several causes are identified, including hypersensitivity to a drug or substance, with the heart as the target organ. However, symptoms and signs of hypersensitivity are not found in all patients. EM can lead to progressive myocardial damage with destruction of the conduction system and refractory heart failure. The present report describes three cases of biopsy-proven EM with different presentations, including acute coronary syndrome, cardiogenic shock and newly diagnosed heart failure. In one patient, hypersensitivity to sumatriptan was suspected to be the underlying cause. All patients responded well to treatment with steroids, angiotensin-converting enzyme inhibitors and beta-blockers. There was a complete recovery of the ventricular function in all cases.

Bien que l’étiologie de la myocardite à éosinophiles (MÉ) ne soit pas toujours apparente, plusieurs causes sont connues, y compris l’hypersensibilité à un médicament ou à une substance, le cœur étant l’organe cible. Cependant, on ne constate pas les symptômes et les signes d’hypersensibilité chez tous les patients. La MÉ peut entraîner des dommages myocardiques évolutifs accompagnés d'une destruction du système de conduction et d’une insuffisance cardiaque réfractaire. Le présent compte rendu décrit trois cas de MÉ démontrée par biopsie sous trois présentations différentes, soit un syndrome coronarien aigu, un choc cardiogène et une insuffisance cardiaque de novo. Chez un patient, l’hypersensibilité au sumatriptan a été présumée comme la cause sousjacente. Tous les patients ont bien réagi à la corticothérapie, à des inhibiteurs de l’enzyme de conversion de l’angiotensine et à des bétabloquants. Dans tous les cas, la fonction ventriculaire s’est complètement rétablie.

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Figures

Figure 1
Figure 1
Electrocardiogram showing minor ST elevation in the inferolateral leads associated with T wave inversion
Figure 2
Figure 2
Supine chest x-ray showing cardiomegaly, bilateral pulmonary edema and right pleural effusion. A pulmonary artery catheter, inserted via the inferior vena cava, with its tip lying in the pulmonary artery, is seen
Figure 3
Figure 3
Representative photomicrograph showing necrotizing eosinophilic myocarditis in the endomyocardial biopsy specimen from case 2. Note the extensive inflammatory cell infiltrate composed of mononuclear inflammatory cells and numerous eosinophils (arrow). Hematoxylin and eosin stain. Bar, 50 μm
Figure 4
Figure 4
Representative photomicrograph of active (A) and healed (B) eosinophilic myocarditis in endomyocardial biopsy specimens from case 3. Active myocarditis (A) shows an inflammatory cell infiltrate containing occasional eosinophils (arrow), while healed myocarditis (B) shows areas of fibrosis (asterisk). Hematoxylin and eosin stain. Bar, 50 μm
See this image and copyright information in PMC

References

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