Eosinophilic myocarditis and hypereosinophilic syndrome

Abstract

Hypereosinophilic syndrome (HES) is a heterogeneous group of hematological disorders characterized by a chronic, unexplained hypereosinophilia with tissue damage. Cardiac involvement occurs in ∼20% of patients with HES and represents a major turning point. Cardiac injuries related to eosinophilia are divided into three chronological phases: eosinophilic infiltration, thrombosis, and fibrosis. We report a case of a 33-year-old woman diagnosed with HES, with pulmonary and gastrointestinal involvement and eosinophilic myocarditis in cardiogenic shock. The evolution was favorable with dobutamine, anticoagulation, corticosteroids, and later, β-blockers and angiotensin-converting enzyme inhibitors. Cardiac involvement in HES is rare but carries a poor prognosis. Corticosteroids are considered by many to be the mainstay of treatment. Although new treatments have been suggested, only a few seem promising.

Keywords: Cardiogenic shock; Corticosteroids; Eosinophilic myocarditis; Hypereosinophilic syndrome; Imatinib.

Figure 1

Abdominal computed tomography showing an important thickening of the gastric antrum walls (arrow) along with an intestinal dilatation.

Figure 2

Transthoracic echocardiography: an apical four-chamber view showing a severe impairment of the left ventricular ejection fraction.