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Case Reports
. 2021 Jun 16;3(6):954-959.
doi: 10.1016/j.jaccas.2021.04.014. eCollection 2021 Jun.

Eosinophilic Myocarditis in a Patient With Strongyloides stercoralis Infection

Yannis Dimitroglou  1 , Thodoris Alexopoulos  2 , Constantina Aggeli  1 , Maria Kalantzi  3 , Anastasia Nouli  4 , Spyridon P Dourakis  2 , Konstantinos Tsioufis  1
Affiliations
Case Reports

Eosinophilic Myocarditis in a Patient With Strongyloides stercoralis Infection

Yannis Dimitroglou et al. JACC Case Rep. .

Abstract

A 40-year-old woman with a pulmonary embolism, central nervous system infarcts, and eosinophilia was referred for evaluation. Findings on echocardiography and cardiac magnetic resonance were consistent with eosinophilic myocarditis with left ventricular involvement. Further examination led to the diagnosis of Strongyloides stercoralis infection, and treatment with ivermectin and rivaroxaban resulted in clinical, laboratory, and cardiac imaging improvement. (Level of Difficulty: Intermediate.).

Keywords: CE, contrast-enhanced transthoracic echocardiography; CMR, cardiac magnetic resonance; CT, computed tomography; ECG, electrocardiogram; LV, left ventricular; cardiac manifestations; cardiovascular imaging; eosinophilia; inflammatory myocarditis; parasitic infection.

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Conflict of interest statement

The authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Figures

None
Graphical abstract
Figure 1
Figure 1
Computed Tomography Pulmonary Angiogram Opacification defects affecting both pulmonary arteries (arrow). A = anterior; L = left; P = posterior; R = right; W = width; L = level.
Figure 2
Figure 2
12- Lead Electrocardiogram at Presentation Sinus rhythm with negative T waves in leads I, II, III, aVF, and V3 to V6.
Figure 3
Figure 3
Transthoracic Echocardiography (A) Long-axis, (B) short-axis, (C) apical 4-chamber, and (D) apical 2-chamber views. The additional tissue affects the basal segments of the inferolateral wall (blue arrows). In the apical views, there is increase of the left ventricular wall thickness in the middle and apical segments. The echogenicity of the inflammatory tissue (red arrows) is different from that of the unaffected myocardium.
Figure 4
Figure 4
Contrast-Enhanced Transthoracic Echocardiography Perfusion of the inflammatory tissue is lower compared to the normal myocardium and contains areas without perfusion (arrow). The latter finding is consistent with left ventricular thrombi.
Figure 5
Figure 5
Cardiac Magnetic Resonance Short-axis late gadolinium enhancement images of the (top) basal, (middle) middle, and (bottom) apical segments. Note the almost circumferential subendocardial enhancement, including the papillary muscles, as well as the mural thrombi within the left ventricle (arrows). The right ventricle appears unaffected.
Figure 6
Figure 6
Echocardiography and CMR at 3-Month Follow-Up (Left) The thickness of the additional inflammatory tissue (echocardiographic images) and (right) the late gadolinium enhancement (cardiac magnetic resonance [CMR] images) have decreased. In addition, left ventricular thrombi have disappeared.
See this image and copyright information in PMC

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