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Biventricular assist device placement and immunosuppression as therapy for necrotizing eosinophilic myocarditis
Leslie T Cooper1, Kenton J Zehr
1Mayo Clinic College of Medicine, Rochester, MN 55905, USA. cooper.leslie@mayo.edu
Insights
A previously healthy woman developed severe cardiac dysfunction due to necrotizing eosinophilic myocarditis. Prompt treatment with immunosuppressants and mechanical support improved her condition.
Area of Science:
- Cardiology
- Immunology
- Pathology
Background:
- A 47-year-old woman with no significant past medical history presented with acute onset of nausea, anorexia, light-headedness, syncope, and pleuritic chest pain.
- Her cardiac function rapidly declined, prompting urgent medical investigation.
Observation:
- Diagnostic investigations included electrocardiography, chest radiography, echocardiography, cardiac enzyme measurements (creatinine phosphokinase and troponin T), coronary angiography, and endomyocardial biopsy.
- The endomyocardial biopsy confirmed necrotizing eosinophilic myocarditis.
Findings:
- Management involved the implantation of a biventricular assist device.
- Treatment included a course of immunosuppressive therapy with methylprednisolone, prednisolone, and mycophenolate mofetil.
Implications:
- This case highlights the importance of considering rare inflammatory cardiomyopathies in the differential diagnosis of acute cardiac dysfunction.
- Early diagnosis and aggressive immunosuppressive therapy are crucial for managing necrotizing eosinophilic myocarditis and improving patient outcomes.
Background:
A previously healthy 47-year-old woman presented reporting nausea, anorexia and light-headedness of 2 weeks' duration, and three episodes of syncope. She also had pleuritic chest pain and rapidly declining cardiac function. The only reported medical history was urinary tract infection and an ankle fracture sustained 5 months before presentation. She was receiving no medication other than estrogen patches for menopause and did not smoke or use illicit drugs.
Investigations:
Electrocardiography, chest radiography, echocardiography, measurement of creatinine phosphokinase and troponin T, coronary angiography and endomyocardial biopsy.
Diagnosis:
Necrotizing eosinophilic myocarditis.
Management:
Biventricular assist device implantation, methylprednisolone, prednisolone and mycophenolate mofetil.
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