Case 305

Area of Science:

• Cardiology
• Immunology
• Internal Medicine

Background:

• A 27-year-old male presented with unexplained fever, thoracic pain, and significant weight loss.
• Initial investigations revealed elevated cardiac biomarkers (high-sensitivity troponin, C-reactive protein) and marked leukocytosis with eosinophilia.
• Exclusion of parasitic and infectious etiologies prompted consideration of inflammatory conditions.

Observation:

• Electrocardiography showed diffuse T-wave inversion, while initial echocardiography indicated normal left ventricular systolic function.
• Subsequent cardiac MRI revealed increased left and right ventricular volumes and mildly reduced ejection fractions, suggesting myocardial involvement.
• Neurological symptoms including headache and blurred vision prompted brain MRI, with cardiac MRI performed shortly after.

Findings:

• Cardiac MRI demonstrated left ventricular end-diastolic volume (LVDV) of 165 mL (89 mL/m² BSA) and left ventricular end-systolic volume (LVSV) of 80 mL (43 mL/m² BSA), with a 52% ejection fraction.
• Right ventricular end-diastolic volume (RVDV) was 163 mL (88 mL/m² BSA) and right ventricular end-systolic volume (RVSV) was 81 mL (44 mL/m² BSA), with a 50% ejection fraction.
• The constellation of symptoms, eosinophilia, and cardiac MRI findings strongly suggested eosinophilic myocarditis.

Implications:

• This case highlights the importance of considering eosinophilic myocarditis in patients with unexplained cardiac symptoms and eosinophilia, especially after excluding infectious causes.
• Corticosteroid therapy was initiated, underscoring its role in managing inflammatory cardiomyopathies.
• Advanced imaging like cardiac MRI is crucial for accurate diagnosis and assessment of myocardial involvement in such cases.