Fulminant Eosinophilic Myocarditis Without Peripheral Eosinophilia.
Ja-Yeon Lee1, Sun Hwa Lee1, Won Ho Kim1
1Division of Cardiology, Department of Internal Medicine, Jeonbuk National University Medical School, Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Korea.
Texas Heart Institute Journal
|April 12, 2023
Summary
Fulminant eosinophilic myocarditis can occur without high eosinophil counts. Early endomyocardial biopsy is crucial for diagnosing this condition and guiding corticosteroid treatment, even with normal peripheral eosinophils.
Area of Science:
- Cardiology
- Immunology
Background:
- Eosinophilic myocarditis involves eosinophilic infiltration of the heart muscle.
- Peripheral hypereosinophilia often accompanies eosinophilic myocarditis.
- Diagnosis and treatment monitoring can be difficult when peripheral eosinophilia is absent.
Purpose of the Study:
- To present a case of fulminant eosinophilic myocarditis with initially normal peripheral eosinophil counts.
- To highlight the diagnostic utility of endomyocardial biopsy in such cases.
- To emphasize the effectiveness of corticosteroids in treating eosinophilic myocarditis.
Main Methods:
- Case report of a patient with fulminant eosinophilic myocarditis.
- Diagnosis confirmed by endomyocardial biopsy.
- Treatment with high-dose corticosteroids.
Main Results:
- The patient presented with normal peripheral eosinophil counts.
- Endomyocardial biopsy revealed eosinophilic infiltration of the myocardium.
- Corticosteroid therapy led to significant clinical improvement.
Conclusions:
- Endomyocardial biopsy is essential for diagnosing eosinophilic myocarditis, particularly in fulminant cases without peripheral eosinophilia.
- Early diagnosis via biopsy facilitates timely corticosteroid treatment.
- Peripheral eosinophil counts are not always reliable indicators in eosinophilic myocarditis.
Related Concept Videos
01:27Myocarditis II: Clinical Features and Diagnostic Tests
14
Myocarditis is an inflammation of the heart muscle. The symptoms vary widely, encompassing asymptomatic presentations to severe, acute manifestations.Clinical PresentationAsymptomatic cases: In some instances, myocarditis may be asymptomatic, with the infection resolving without intervention. These cases often go undetected unless discovered incidentally through diagnostic imaging or tests conducted for other reasons.General Early Symptoms: Early symptoms of myocarditis are non-specific and can...
14
01:21Myocarditis I: Introduction
14
Myocarditis is inflammation of the myocardium, which is the muscular layer of the heart.EtiologyMyocarditis has a diverse etiology, including a wide range of infectious and non-infectious causes:Infectious CausesViral: Common viruses include Coxsackie A and B, adenovirus, parvovirus B19, enteroviruses, and influenza A.Bacterial: Examples include infections caused by Streptococcus, Staphylococcus, and Mycoplasma species.Rickettsial: Infections like Rocky Mountain spotted fever can result in...
14
01:14Myocarditis III: Medical Management
10
Myocarditis: Comprehensive Medical ManagementMyocarditis, the heart muscle inflammation, requires a comprehensive medical management strategy that addresses the underlying cause, provides supportive care, manages symptoms, and reduces cardiac workload.Infections and Autoimmune CausesAdminister appropriate antimicrobial therapy when an infectious agent causes myocarditis. For instance, penicillin treats infections caused by Group A Streptococcus. In cases where autoimmune processes are...
10
01:29Cardiomyopathy IV: Restrictive Cardiomyopathy
13
Restrictive cardiomyopathy (RCM) is a rare heart muscle disease characterized by impaired ventricular filling due to stiffened ventricular walls, leading to significant diastolic dysfunction.EtiologyRestrictive cardiomyopathy can arise from both inherited and acquired diseases, many of which are systemic. It is categorized into four main types: infiltrative, storage, non-infiltrative, and endomyocardial diseases.Infiltrative diseases, such as amyloidosis, lead to RCM by depositing amyloid...
13
01:29Cardiomyopathy III: Hypertrophic Cardiomyopathy
18
Hypertrophic cardiomyopathy, or HCM, is an autosomal dominant genetic disorder characterized by asymmetric left ventricular hypertrophy without ventricular dilation. It is more common in men and is typically diagnosed in young, athletic adults.EtiologyHCM is primarily genetic and is caused by mutations in genes encoding sarcomeric proteins. Researchers have identified over 1400 mutations across at least 11 different genes. Among these, the most frequently occurring mutations are found in the...
18
01:22Myocarditis IV: Nursing Management
14
Myocarditis is an inflammatory condition of the myocardium requiring meticulous nursing management for optimal patient outcomes. Effective management begins with a thorough assessment of the patient's medical history, paying close attention to past infections, autoimmune disorders, travel history, and exposure to toxins or drugs. Recent viral infections and systemic diseases are particularly relevant due to their potential role in triggering myocarditis.Physical Examination and MonitoringThe...
14