Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2024 Mar 14;12(3):656.
doi: 10.3390/biomedicines12030656.

Eosinophilic Myocarditis: From Bench to Bedside

Francesco Piccirillo  1   2 , Sara Mastroberardino  1   2 , Vincenzo Nafisio  1   2 , Matteo Fiorentino  1   2 , Andrea Segreti  1   2   3 , Annunziata Nusca  1   2 , Gian Paolo Ussia  1   2 , Francesco Grigioni  1   2
Affiliations
Review

Eosinophilic Myocarditis: From Bench to Bedside

Francesco Piccirillo et al. Biomedicines. .

Abstract

Myocarditis is a polymorphic and potentially life-threatening disease characterized by a large variability in clinical presentation and prognosis. Within the broad spectrum of etiology, eosinophilic myocarditis represents a rare condition characterized by eosinophilic infiltration of the myocardium, usually associated with peripheral eosinophilia. Albeit uncommon, eosinophilic myocarditis could be potentially life-threatening, ranging from mild asymptomatic disease to multifocal widespread infiltrates associated with myocardial necrosis, thrombotic complications, and endomyocardial fibrosis. Moreover, it could progress to dilated cardiomyopathy, resulting in a poor prognosis. The leading causes of eosinophilic myocarditis are hypersensitivity reactions, eosinophilic granulomatosis with polyangiitis, cancer, hyper-eosinophilic syndrome variants, and infections. A thorough evaluation and accurate diagnosis are crucial to identifying the underlying cause and defining the appropriate therapeutic strategy. On these bases, this comprehensive review aims to summarize the current knowledge on eosinophilic myocarditis, providing a schematic and practical approach to diagnosing, evaluating, and treating eosinophilic myocarditis.

Keywords: cardiomyopathy; endomyocardial fibrosis; eosinophilic granulomatosis with polyangiitis; eosinophilic myocarditis; hyper-eosinophilic syndrome; myocarditis.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Pathophysiology and mechanism of damage in eosinophilic myocarditis. Abbreviations. ECP = eosinophilic cationic protein; gm-csf = granulocyte/macrophage colony-stimulating factor; IL-3 = interleukin 3; IL-5 = interleukin 5; MBP = major basic protein.
Figure 2
Figure 2
Clinical manifestations of eosinophilic myocarditis, related to different organs involved. Abbreviations. EGPA = eosinophilic granulomatosis with polyangiitis.
Figure 3
Figure 3
CMR findings in patients with EGPA-eosinophilic myocarditis. LGE images show sub-endocardial hyperintensity involving the mid-apical ventricular segments and focal areas of infra-myocardial hyperintensity in correspondence with the inferior septum in the basal and mid-apical regions.
Figure 4
Figure 4
EMB in eosinophilic myocarditis. Hematoxylin and eosin staining shows eosinophilic infiltrate and diffuse myocardial damage with necrosis and subversion of myocardial tissue structure.
Figure 5
Figure 5
“Red flags” in eosinophilic myocarditis. Abbreviations. ANCA = anti-neutrophil cytoplasmatic antibodies; EM = eosinophilic myocarditis; LGE = late gadolinium enhancement.
See this image and copyright information in PMC

References

    1. Piccirillo F., Watanabe M., Di Sciascio G. Diagnosis, Treatment and Predictors of Prognosis of Myocarditis. A Narrative Review. Cardiovasc. Pathol. 2021;54:107362. doi: 10.1016/j.carpath.2021.107362. - DOI - PubMed
    1. Watanabe M., Panetta G.L., Piccirillo F., Spoto S., Myers J., Serino F.M., Costantino S., Di Sciascio G. Acute Epstein-Barr Related Myocarditis: An Unusual but Life-Threatening Disease in an Immunocompetent Patient. J. Cardiol. Cases. 2020;21:137–140. doi: 10.1016/j.jccase.2019.12.001. - DOI - PMC - PubMed
    1. Brambatti M., Matassini M.V., Adler E.D., Klingel K., Camici P.G., Ammirati E. Eosinophilic Myocarditis. J. Am. Coll. Cardiol. 2017;70:2363–2375. doi: 10.1016/j.jacc.2017.09.023. - DOI - PubMed
    1. Caforio A.L.P., Pankuweit S., Arbustini E., Basso C., Gimeno-Blanes J., Felix S.B., Fu M., Heliö T., Heymans S., Jahns R., et al. Current State of Knowledge on Aetiology, Diagnosis, Management, and Therapy of Myocarditis: A Position Statement of the European Society of Cardiology Working Group on Myocardial and Pericardial Diseases. Eur. Heart J. 2013;34:2636–2648, 2648a–2648d. doi: 10.1093/eurheartj/eht210. - DOI - PubMed
    1. Ginsberg F., Parrillo J.E. Eosinophilic Myocarditis. Heart Fail. Clin. 2005;1:419–429. doi: 10.1016/j.hfc.2005.06.013. - DOI - PubMed

LinkOut - more resources