Eosinophilic explant carditis with eosinophilia: ?Hypersensitivity to dobutamine infusion

Eosinophilic carditis with peripheral eosinophilia has been observed in a number of clinical situations. This report describes this association in patients undergoing heart transplantation and offers a possible explanation.

The clinical records and explanted hearts of 31 consecutive patients who received primary orthotopic heart transplants were reviewed. Clinical features particularly analyzed included the following: age, cardiac status and assistance devices, catheterizations, medical or surgical disorders including parasites, tryptophane exposure, medications, and peripheral blood counts. Pathologic features particularly studied included the following: dilatation and hypertrophy, fibrosis, mural thrombi, carditis, eosinophils, myocardial necrosis, vasculitis, valvular disease, and coronary artery disease. Prior endomyocardial biopsy specimens were also reviewed.

Seven patients had eosinophilic carditis compatible with hypersensitivity carditis. Eight had eosinophilia. All patients with carditis received intravenous dobutamine (Dobutrex solution) continuously for more than 1 month immediately preceding transplantation. All patients with eosinophilia received intravenous dobutamine continuously for 15 days or longer and exhibited eosinophilia only during dobutamine therapy with the exception of one patient in whom eosinophilia was observed 8 days after cessation of 8 days of therapy. Among 13 patients who received dobutamine for more than a month immediately before transplantation, nine had eosinophilic carditis, peripheral eosinophilia, or both.

Prolonged continuous intravenous administration of dobutamine was associated with eosinophilic carditis and eosinophilia. No other clinical factor with a relationship to either eosinophilia or carditis was identified. The responsible agent may have been a preservative in the dobutamine solution, sodium bisulfite.