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Case Reports
. 2022 Sep 16;6(9):ytac388.
doi: 10.1093/ehjcr/ytac388. eCollection 2022 Sep.

A case series of eosinophilic myocarditis: different faces of the same coin

Bethlehem Mengesha  1 , Karen Meir  2 , Alexander Gural  3 , Rabea Asleh  1
Affiliations
Case Reports

A case series of eosinophilic myocarditis: different faces of the same coin

Bethlehem Mengesha et al. Eur Heart J Case Rep. .

Abstract

Background: Eosinophilic myocarditis (EM) is a rare form of myocarditis with various aetiologies and dire consequences if not diagnosed and treated expeditiously.

Case summary: We report three cases of EM at different stages of the disease with differing clinical manifestations. We highlight the diagnostic workup including the role of multimodality imaging and endomyocardial biopsy (EMB), and the treatment strategies.

Discussion: EM is an underdiagnosed and potentially life-threatening disease. Therefore, a high clinical suspicion for EM should arise when patients with signs and symptoms of cardiovascular disease develop hypereosinophilia or vice versa. Early identification of this condition using multimodality imaging and EMB is of paramount importance as the disease may progress to the irreversible late fibrotic stage if treatment is delayed.

Keywords: Case series; Eosinophilic myocarditis; Heart failure; Hypereosinophilia.

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Figures

Figure 1
Figure 1
Cardiac magnetic resonance imaging (3T). Native T1 (A) and native T2 (B) mapping in the short-axis view show increased T1 and T2 values (1342 and 68 ms, respectively). (C) A short axis phase-sensitive inversion recovery image shows a mid-wall late gadolinium enhancement in the inferolateral and septal region.
Figure 2
Figure 2
Endomyocardial and bone marrow biopsy. (A). Bone marrow biopsy sections show markedly hypercellular trilineage bone marrow (haematoxylin and eosin; original magnification × 40), with abundant maturing and mature eosinophilic myeloid lineage cells (B); haematoxylin and eosin; original magnification × 400). (C) Endomyocardial biopsy showing eosinophilic (arrows) and mononuclear cell infiltration of the perivascular and interstitial space without myofiber necrosis (haematoxylin and eosin; original magnification × 400).
Figure 3
Figure 3
Cardiac magnetic resonance imaging (3T). A four- (A) and three-chamber view (B) showing a sub-endocardial late gadolinium enhancement consistent with apical fibrosis with a superimposed laminated clot creating the ‘double V’ sign. A four- (C) and three-chamber (D) steady-state free precession still image showing increased focal apical wall thickness.
Figure 4
Figure 4
Endomyocardial biopsy. (A, B). Endomyocardial tissue with interstitial oedema, scattered eosinophils (arrows) (haematoxylin and eosin; original magnification × 600), and macrophage infiltration (C, arrowheads) of the perivascular and interstitial space without necrosis of myofibers (haematoxylin and eosin; original magnification × 600).
Figure 5
Figure 5
Cardiac magnetic resonance imaging (1.5T). A two-chamber view (A) show patchy late gadolinium enhancement mainly on the apical region. A short axis view (B) shows a sub-epicardial late gadolinium enhancement on the antero-septal and anterior segment.
See this image and copyright information in PMC

References

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