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Harmouch W, Zhang JR, Peterson JM, Uran DP, Buja LM, Zhao B, Boor PJ, Murrieta JI, Chatila K, Stevenson HL. A challenging case of eosinophilic myocarditis leading to heart failure and transplantation. Cardiovasc Pathol 2024; 72:107666. [PMID: 38871199 DOI: 10.1016/j.carpath.2024.107666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 05/30/2024] [Accepted: 06/01/2024] [Indexed: 06/15/2024] Open
Abstract
The large spectrum of etiologies, severities, and histologic appearances of eosinophilic myocarditis (EoM) poses challenges to its diagnosis and management. Endomyocardial biopsy is the current gold standard for diagnosis. However, cardiovascular magnetic resonance imaging is becoming more frequently used to diagnose acute myocarditis because of enhanced sensitivity when compared to histopathologic examination, and its less invasive nature. We report a complicated case of EoM in a male in his mid-thirties that led to fulminant cardiogenic shock that required immunosuppressive therapy on day 5 of admission and implantation of a left ventricular assist device (LVAD) on day 30. EoM was diagnosed on histopathologic examination of the resected fragment of the left ventricular myocardium. Nine months after the initial presentation, the patient ultimately required heart transplantation. The explanted heart showed minimal residual interstitial inflammation with evidence of mildly active intimal arteritis and patchy areas of interstitial fibrosis. In this report, we describe our patient's clinical features and correlate them with imaging and histopathologic findings to illustrate the difficulty in diagnosing EoM, particularly in this complicated patient that ultimately required heart transplantation. The diagnosis can be challenging due to the variable histopathologic features, clinical presentation, and utilization of therapeutic medications and devices.
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Affiliation(s)
- Wissam Harmouch
- Departments of Internal Medicine, University of Texas Medical Branch, Galveston, Texas, USA.
| | - Jared R Zhang
- John Sealy School of Medicine, University of Texas Medical Branch, Galveston, Texas, USA
| | - Joshua M Peterson
- Departments of Pathology, University of Texas Medical Branch, Galveston, Texas, USA
| | - Diana Palacio Uran
- Departments of Radiology, University of Texas Medical Branch, Galveston, Texas, USA
| | - Louis Maximilian Buja
- Department of Pathology and Laboratory Medicine, University of Texas Health Science Center, Houston, Texas, USA; Cardiovascular Pathology Research Laboratory, Texas Heart Institute, CHI St. Luke's Hospital, Houston, Texas, USA
| | - Bihong Zhao
- Department of Pathology and Laboratory Medicine, University of Texas Health Science Center, Houston, Texas, USA
| | - Paul J Boor
- Departments of Pathology, University of Texas Medical Branch, Galveston, Texas, USA
| | - Jose Iturrizaga Murrieta
- Departments of Division of Cardiovascular Medicine, University of Texas Medical Branch, Galveston, Texas, USA
| | - Khaled Chatila
- Departments of Division of Cardiovascular Medicine, University of Texas Medical Branch, Galveston, Texas, USA
| | - Heather L Stevenson
- Departments of Pathology, University of Texas Medical Branch, Galveston, Texas, USA
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2
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Won T, Song EJ, Kalinoski HM, Moslehi JJ, Čiháková D. Autoimmune Myocarditis, Old Dogs and New Tricks. Circ Res 2024; 134:1767-1790. [PMID: 38843292 DOI: 10.1161/circresaha.124.323816] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Accepted: 05/08/2024] [Indexed: 06/12/2024]
Abstract
Autoimmunity significantly contributes to the pathogenesis of myocarditis, underscored by its increased frequency in autoimmune diseases such as systemic lupus erythematosus and polymyositis. Even in cases of myocarditis caused by viral infections, dysregulated immune responses contribute to pathogenesis. However, whether triggered by existing autoimmune conditions or viral infections, the precise antigens and immunologic pathways driving myocarditis remain incompletely understood. The emergence of myocarditis associated with immune checkpoint inhibitor therapy, commonly used for treating cancer, has afforded an opportunity to understand autoimmune mechanisms in myocarditis, with autoreactive T cells specific for cardiac myosin playing a pivotal role. Despite their self-antigen recognition, cardiac myosin-specific T cells can be present in healthy individuals due to bypassing the thymic selection stage. In recent studies, novel modalities in suppressing the activity of pathogenic T cells including cardiac myosin-specific T cells have proven effective in treating autoimmune myocarditis. This review offers an overview of the current understanding of heart antigens, autoantibodies, and immune cells as the autoimmune mechanisms underlying various forms of myocarditis, along with the latest updates on clinical management and prospects for future research.
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Affiliation(s)
- Taejoon Won
- Department of Pathobiology, College of Veterinary Medicine, University of Illinois Urbana-Champaign (T.W.)
| | - Evelyn J Song
- Section of Cardio-Oncology and Immunology, Division of Cardiology and the Cardiovascular Research Institute, University of California San Francisco (E.J.S., J.J.M.)
| | - Hannah M Kalinoski
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD (H.M.K., D.Č)
| | - Javid J Moslehi
- Section of Cardio-Oncology and Immunology, Division of Cardiology and the Cardiovascular Research Institute, University of California San Francisco (E.J.S., J.J.M.)
| | - Daniela Čiháková
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD (H.M.K., D.Č)
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD (D.Č)
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3
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Trovato V, Asada A, Fussner L, Curtis C, Kahwash R. Interleukin-5 Antagonist Monoclonal Antibody Therapy Improves Symptoms and Reduces Steroid Dependence in Eosinophilic Myocarditis Patients. JACC Case Rep 2024; 29:102267. [PMID: 38645295 PMCID: PMC11031656 DOI: 10.1016/j.jaccas.2024.102267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 01/19/2024] [Accepted: 01/22/2024] [Indexed: 04/23/2024]
Abstract
Eosinophilic myocarditis (EM) is a rare disease associated with significant morbidity and mortality. This case series follows the clinical courses of 3 patients with EM. The use of mepolizumab, an anti-interleukin-5 monoclonal antibody, as an adjunctive treatment was associated with stabilization of cardiac function and improved long-term outcomes.
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Affiliation(s)
- Vincenzo Trovato
- Division of Cardiovascular Medicine, Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Ashlee Asada
- Department of Internal Medicine, Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Lynn Fussner
- Division of Pulmonary, Critical Care, and Sleep Medicine, Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Casey Curtis
- Division of Allergy and Immunology, Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Rami Kahwash
- Division of Cardiovascular Medicine, Ohio State University Wexner Medical Center, Columbus, Ohio, USA
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4
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Yeo SZJ, Ho CL. COVID-19 mRNA vaccine-related myocarditis: A PRISMA systematic review, imaging approach and differential diagnoses. Radiol Case Rep 2024; 19:1008-1019. [PMID: 38226053 PMCID: PMC10788373 DOI: 10.1016/j.radcr.2023.11.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 11/28/2023] [Indexed: 01/17/2024] Open
Abstract
We present a case involving a young individual who developed acute myocarditis on the fourth day following administration of a COVID-19 mRNA vaccine. The patient's condition was managed conservatively, resulting in a favorable outcome. This paper extensively discusses the pathogenesis, clinical manifestations, imaging characteristics of COVID-19 mRNA vaccine-related myocarditis and includes a comprehensive review of pertinent literature. Additionally, a systematic review of COVID-19 mRNA vaccine-related myocarditis, conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) principles, is presented. Healthcare professionals should maintain a clinical suspicion for COVID-19 mRNA vaccine-related myocarditis when encountering patients with confirmed myocarditis who have received recent COVID-19 mRNA vaccination, after ruling out other potential causes. The diagnosis of acute myocarditis primarily relies on adherence to the Lake Louise Criteria (LLC) for cardiac magnetic resonance (CMR). Nevertheless, specific CMR features or distinctive patterns indicative of COVID-19 mRNA vaccine-related myocarditis are currently undefined. Among patients with vaccine-related myocarditis, common CMR findings encompass subepicardial late gadolinium enhancement and T2-based myocardial edema, although these findings lack specificity and may resemble other medical conditions. Supportive care involving a short-term regimen of NSAIDs, colchicine, and steroids represents the cornerstone of treatment for this variant of myocarditis, which tends to be self-limiting with favorable short-term prognoses. Timely diagnosis is paramount for optimizing patient care.
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Affiliation(s)
| | - Chi Long Ho
- Sengkang General Hospital, 110, Sengkang Eastway, 544886, Singapore
- Duke-NUS Medical School, 8 College Rd, 169857, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
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Hengst D, Kandah D, Dervesh R, Ellerman M, Ugwu J, Goerbig-Campbell J, Campbell D. Eosinophilic Myocarditis Resulting in Ventricular Tachycardia Storm. Cureus 2024; 16:e56779. [PMID: 38650811 PMCID: PMC11034619 DOI: 10.7759/cureus.56779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2024] [Indexed: 04/25/2024] Open
Abstract
Eosinophilic myocarditis (EM) is a rare but potentially fatal complication of sustained eosinophilia that is characterized by eosinophilic infiltration into myocardial tissue. There are various etiologies of EM that can be classified into general categories: reactive, clonal, and idiopathic. We present a case of EM caused by chronic eosinophilic leukemia, a rare myeloproliferative neoplasm that frequently presents with sustained peripheral eosinophilia. This case displays several serious complications of EM, including recurrent ventricular tachycardia storm, cardiogenic shock, and mural thrombus formation despite anticoagulation. Diagnosis of EM can be difficult as formal diagnosis requires an endomyocardial biopsy. Once EM is suspected, identifying the underlying etiology of eosinophilia is critical for timely implementation of disease-specific therapy.
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Affiliation(s)
- Dylan Hengst
- Internal Medicine, MercyOne Des Moines Medical Center, Des Moines, USA
| | - Daniel Kandah
- Cardiology, MercyOne Des Moines Medical Center, Des Moines, USA
| | | | | | - Justin Ugwu
- Interventional Cardiology, University of Kansas Medical Center, Kansas City, USA
| | | | - Dwayne Campbell
- Cardiology, MercyOne Des Moines Medical Center, Des Moines, USA
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6
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Liu K, Han B. Role of immune cells in the pathogenesis of myocarditis. J Leukoc Biol 2024; 115:253-275. [PMID: 37949833 DOI: 10.1093/jleuko/qiad143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 10/15/2023] [Accepted: 10/24/2023] [Indexed: 11/12/2023] Open
Abstract
Myocarditis is an inflammatory heart disease that mostly affects young people. Myocarditis involves a complex immune network; however, its detailed pathogenesis is currently unclear. The diversity and plasticity of immune cells, either in the peripheral blood or in the heart, have been partially revealed in a number of previous studies involving patients and several kinds of animal models with myocarditis. It is the complexity of immune cells, rather than one cell type that is the culprit. Thus, recognizing the individual intricacies within immune cells in the context of myocarditis pathogenesis and finding the key intersection of the immune network may help in the diagnosis and treatment of this condition. With the vast amount of cell data gained on myocarditis and the recent application of single-cell sequencing, we summarize the multiple functions of currently recognized key immune cells in the pathogenesis of myocarditis to provide an immune background for subsequent investigations.
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Affiliation(s)
- Keyu Liu
- Department of Pediatric Cardiology, Shandong Provincial Hospital, Shandong University, Cheeloo Colledge of Medicine, No. 324 Jingwu Road, 250021, Jinan, China
| | - Bo Han
- Department of Pediatric Cardiology, Shandong Provincial Hospital, Shandong University, Cheeloo Colledge of Medicine, No. 324 Jingwu Road, 250021, Jinan, China
- Department of Pediatric Cardiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No. 324 Jingwu Road, 250021, Jinan, China
- Shandong Provincial Hospital, Shandong Provincial Clinical Research Center for Children' s Health and Disease office, No. 324 Jingwu Road, 250021, Jinan, China
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Collini V, Burelli M, Favaretto V, Pegolo E, Fumarola F, Lepre V, Pellin L, Taurian M, Quartuccio L, Imazio M, Sinagra G. Eosinophilic myocarditis: comprehensive update on pathophysiology, diagnosis, prognosis and management. Minerva Cardiol Angiol 2023; 71:535-552. [PMID: 37161920 DOI: 10.23736/s2724-5683.23.06287-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Hypereosinophilic syndromes are a group of disorders secondary to the accumulation of eosinophils leading to the injury of one or more organs. Among them, eosinophilic myocarditis (EM) is a rare form of inflammatory cardiomyopathy characterized by eosinophilic infiltration into myocardial tissue and subsequent release of substances with cell membrane damage and cell destruction. The degree of infiltration is thought to depend on the underlying condition, as well as the degree and duration of eosinophil exposure and ranges from mild localized disease to diffuse multifocal infiltrates associated with myocardial necrosis, thrombotic complications and endomyocardial fibrosis. The main causes of EM are hypersensitivity reactions, eosinophilic granulomatosis with polyangiitis, hypereosinophilic syndrome variants, infections and cancer. Clinical presentation can be variable, ranging from asymptomatic forms to life-threatening conditions, to chronic heart failure due to progression to chronic restrictive cardiomyopathy. Marked eosinophilia in peripheral blood, elevated serum eosinophilic cationic protein concentration and multimodality imaging may suggest the etiology of EM, but in most cases an endomyocardial biopsy must be performed to establish a definitive diagnosis. Systemic treatment varies greatly depending on the underlying cause, however the evidence of an eosinophilic infiltrate allows initiation of immunosuppressive therapy, which is the mainstay of treatment in idiopathic and in most forms of EM. Patients with helminthic infection benefit from anti-parasitic therapy, those with myeloid clone often need a tyrosine kinase inhibitor, while anticoagulant therapy should be undertaken in case of possible thrombotic complications.
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Affiliation(s)
- Valentino Collini
- Unit of Cardiology, Cardiothoracic Department, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Udine, Italy -
- Center for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), University of Trieste, Trieste, Italy -
| | - Massimo Burelli
- Unit of Cardiology, Cardiothoracic Department, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Udine, Italy
- Center for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), University of Trieste, Trieste, Italy
| | - Virginia Favaretto
- Unit of Cardiology, Cardiothoracic Department, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Udine, Italy
- Center for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), University of Trieste, Trieste, Italy
| | - Enrico Pegolo
- Institute of Anatomic Pathology, Department of Medical and Biological Sciences, University Hospital of Santa Maria della Misericordia, Udine, Italy
| | - Francesca Fumarola
- Unit of Cardiology, Cardiothoracic Department, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Udine, Italy
- Center for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), University of Trieste, Trieste, Italy
| | - Veronica Lepre
- Unit of Cardiology, Cardiothoracic Department, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Udine, Italy
- Center for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), University of Trieste, Trieste, Italy
| | - Lisa Pellin
- Unit of Cardiology, Cardiothoracic Department, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Udine, Italy
- Center for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), University of Trieste, Trieste, Italy
| | - Marco Taurian
- Unit of Cardiology, Cardiothoracic Department, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Udine, Italy
- Center for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), University of Trieste, Trieste, Italy
| | - Luca Quartuccio
- Unit of Rheumatology, Department of Medicine (DAME), University of Udine, Udine, Italy
| | - Massimo Imazio
- Unit of Cardiology, Cardiothoracic Department, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Udine, Italy
| | - Gianfranco Sinagra
- Center for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), University of Trieste, Trieste, Italy
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Lee JY, Lee SH, Kim WH. Fulminant Eosinophilic Myocarditis Without Peripheral Eosinophilia. Tex Heart Inst J 2023; 50:492235. [PMID: 37044058 PMCID: PMC10178658 DOI: 10.14503/thij-21-7818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Abstract
Eosinophilic myocarditis is a rare form of myocarditis characterized by eosinophilic infiltration and usually associated with peripheral hypereosinophilia. The clinical spectrum of eosinophilic myocarditis ranges widely, from mildly symptomatic to fulminant disease. When patients have fulminant eosinophilic myocarditis, high-dose corticosteroids can lead to dramatic improvement and peripheral eosinophil counts are used as an indicator of response to treatment. However, in some patients, peripheral eosinophilia is absent at initial presentation; reaching a diagnosis and determining treatment response can be challenging in this situation. This report describes a patient with fulminant eosinophilic myocarditis who initially presented with a normal peripheral eosinophil count, was diagnosed through an early endomyocardial biopsy, and was successfully treated with corticosteroids. Endomyocardial biopsy should be performed to confirm the presence of myocardial eosinophilic infiltration, especially for patients who present with fulminant myocarditis, even when peripheral eosinophilia is absent.
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Affiliation(s)
- Ja-Yeon Lee
- Division 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
| | - Sun Hwa Lee
- Division 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
| | - Won Ho Kim
- Division 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
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Badawy M, Revzin MV, Consul N, Soliman M, Ganeshan DM, Heymann JC, Gaballah AH, Rao Korivi B, Morani AC, Javadi S, Elsayes KM. Paraneoplastic Syndromes from Head to Toe: Pathophysiology, Imaging Features, and Workup. Radiographics 2023; 43:e220085. [PMID: 36795597 DOI: 10.1148/rg.220085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
Patients often have symptoms due to the mass effect of a neoplasm on surrounding tissues or the development of distant metastases. However, some patients may present with clinical symptoms that are not attributable to direct tumor invasion. In particular, certain tumors may release substances such as hormones or cytokines or trigger an immune cross-reactivity between malignant and normal body cells, resulting in characteristic clinical features that are broadly referred to as paraneoplastic syndromes (PNSs). Recent advances in medicine have improved the understanding of the pathogenesis of PNSs and enhanced their diagnosis and treatment. It is estimated that 8% of patients with cancer develop a PNS. Diverse organ systems may be involved, most notably the neurologic, musculoskeletal, endocrinologic, dermatologic, gastrointestinal, and cardiovascular systems. Knowledge of various PNSs is necessary, as these syndromes may precede tumor development, complicate the patient's clinical presentation, indicate tumor prognosis, or be mistaken for metastatic spread. Radiologists should be familiar with the clinical presentations of common PNSs and the selection of appropriate imaging examinations. Many of these PNSs have imaging features that can assist with arriving at the correct diagnosis. Therefore, the key radiographic findings associated with these PNSs and the diagnostic pitfalls that can be encountered during imaging are important, as their detection can facilitate early identification of the underlying tumor, reveal early recurrence, and enable monitoring of the patient's response to therapy. © RSNA, 2023 Quiz questions for this article are available in the supplemental material.
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Affiliation(s)
- Mohamed Badawy
- From the Department of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030 (M.B., D.M.G., B.R.K., A.C.M., S.J., K.M.E.); Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Conn (M.V.R.); Department of Diagnostic Radiology, Baylor College of Medicine, Houston, Tex (N.C.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (M.S.); Department of Diagnostic Radiology, University of Texas Medical Branch, Galveston, Tex (J.C.H.); and Department of Radiology, University of Missouri School of Medicine, Columbia, Mo (A.H.G.)
| | - Margarita V Revzin
- From the Department of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030 (M.B., D.M.G., B.R.K., A.C.M., S.J., K.M.E.); Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Conn (M.V.R.); Department of Diagnostic Radiology, Baylor College of Medicine, Houston, Tex (N.C.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (M.S.); Department of Diagnostic Radiology, University of Texas Medical Branch, Galveston, Tex (J.C.H.); and Department of Radiology, University of Missouri School of Medicine, Columbia, Mo (A.H.G.)
| | - Nikita Consul
- From the Department of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030 (M.B., D.M.G., B.R.K., A.C.M., S.J., K.M.E.); Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Conn (M.V.R.); Department of Diagnostic Radiology, Baylor College of Medicine, Houston, Tex (N.C.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (M.S.); Department of Diagnostic Radiology, University of Texas Medical Branch, Galveston, Tex (J.C.H.); and Department of Radiology, University of Missouri School of Medicine, Columbia, Mo (A.H.G.)
| | - Moataz Soliman
- From the Department of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030 (M.B., D.M.G., B.R.K., A.C.M., S.J., K.M.E.); Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Conn (M.V.R.); Department of Diagnostic Radiology, Baylor College of Medicine, Houston, Tex (N.C.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (M.S.); Department of Diagnostic Radiology, University of Texas Medical Branch, Galveston, Tex (J.C.H.); and Department of Radiology, University of Missouri School of Medicine, Columbia, Mo (A.H.G.)
| | - Dhakshina M Ganeshan
- From the Department of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030 (M.B., D.M.G., B.R.K., A.C.M., S.J., K.M.E.); Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Conn (M.V.R.); Department of Diagnostic Radiology, Baylor College of Medicine, Houston, Tex (N.C.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (M.S.); Department of Diagnostic Radiology, University of Texas Medical Branch, Galveston, Tex (J.C.H.); and Department of Radiology, University of Missouri School of Medicine, Columbia, Mo (A.H.G.)
| | - John C Heymann
- From the Department of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030 (M.B., D.M.G., B.R.K., A.C.M., S.J., K.M.E.); Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Conn (M.V.R.); Department of Diagnostic Radiology, Baylor College of Medicine, Houston, Tex (N.C.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (M.S.); Department of Diagnostic Radiology, University of Texas Medical Branch, Galveston, Tex (J.C.H.); and Department of Radiology, University of Missouri School of Medicine, Columbia, Mo (A.H.G.)
| | - Ayman H Gaballah
- From the Department of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030 (M.B., D.M.G., B.R.K., A.C.M., S.J., K.M.E.); Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Conn (M.V.R.); Department of Diagnostic Radiology, Baylor College of Medicine, Houston, Tex (N.C.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (M.S.); Department of Diagnostic Radiology, University of Texas Medical Branch, Galveston, Tex (J.C.H.); and Department of Radiology, University of Missouri School of Medicine, Columbia, Mo (A.H.G.)
| | - Brinda Rao Korivi
- From the Department of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030 (M.B., D.M.G., B.R.K., A.C.M., S.J., K.M.E.); Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Conn (M.V.R.); Department of Diagnostic Radiology, Baylor College of Medicine, Houston, Tex (N.C.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (M.S.); Department of Diagnostic Radiology, University of Texas Medical Branch, Galveston, Tex (J.C.H.); and Department of Radiology, University of Missouri School of Medicine, Columbia, Mo (A.H.G.)
| | - Ajaykumar C Morani
- From the Department of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030 (M.B., D.M.G., B.R.K., A.C.M., S.J., K.M.E.); Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Conn (M.V.R.); Department of Diagnostic Radiology, Baylor College of Medicine, Houston, Tex (N.C.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (M.S.); Department of Diagnostic Radiology, University of Texas Medical Branch, Galveston, Tex (J.C.H.); and Department of Radiology, University of Missouri School of Medicine, Columbia, Mo (A.H.G.)
| | - Sanaz Javadi
- From the Department of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030 (M.B., D.M.G., B.R.K., A.C.M., S.J., K.M.E.); Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Conn (M.V.R.); Department of Diagnostic Radiology, Baylor College of Medicine, Houston, Tex (N.C.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (M.S.); Department of Diagnostic Radiology, University of Texas Medical Branch, Galveston, Tex (J.C.H.); and Department of Radiology, University of Missouri School of Medicine, Columbia, Mo (A.H.G.)
| | - Khaled M Elsayes
- From the Department of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030 (M.B., D.M.G., B.R.K., A.C.M., S.J., K.M.E.); Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Conn (M.V.R.); Department of Diagnostic Radiology, Baylor College of Medicine, Houston, Tex (N.C.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (M.S.); Department of Diagnostic Radiology, University of Texas Medical Branch, Galveston, Tex (J.C.H.); and Department of Radiology, University of Missouri School of Medicine, Columbia, Mo (A.H.G.)
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10
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Sharifkazemi M, Rezaian G, Lotfi M. Evaluation of myocardial performance by serial speckle tracking echocardiography in diagnosis and follow-up of a patient with eosinophilic myocarditis. Echo Res Pract 2023; 10:1. [PMID: 36698163 PMCID: PMC9878865 DOI: 10.1186/s44156-022-00013-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 11/25/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Speckle tracking echocardiography (STE) has been used as an adjunct diagnostic modality in patients with eosinophilic myocarditis. Its serial dynamic nature, however, has never been reported before. CASE PRESENTATION A 17-year-old boy presented in cardiogenic shock state. His full blood count revealed an absolute eosinophilic count of 11.18 × 103/μL. An emergency 2D echocardiogram (2DE) showed global left ventricular hypokinesia with LVEF = 9.0% by Simpson's method and a large amount of pericardial effusion. STE showed a global longitudinal strain (GLS) of - 4.1%. Because of his poor clinical status and presence of marked hypereosinophilia and the possibility of eosinophilic myocarditis (EM), parenteral pulse therapy with methylprednisolone and inotropes was started with subsequent improvement within the next 48 h. Over the next few days, he had his first cardiovascular magnetic resonance imaging (CMR), which showed late gadolinium enhancement (LGE) in different cardiac regions. After two weeks of therapy, he left the hospital in a stable condition, with LVEF = 38.0%, and GLS = - 13.9%. He did well during his two months of outpatient follow-ups and was found to have an absolute eosinophil count of 0.0% on several occasions. Unfortunately, he was re-admitted because of treatment non-compliance with almost the same, albeit milder, symptoms. The WBC count was 18.1 × 103 per microliter, and the eosinophilic count was 5.04 × 103/μL (28%). Heart failure treatment and high-dose prednisolone were started. After 15 days of admission, he got better and was discharged. During both hospital admissions and several months of follow-up, he had multiple 2DEs, STE, and two CMR studies. None of his STEs were identical to the prior studies and were dynamic with frequent wax and wanes throughout the admissions and follow-ups. Thus a single admission-time STE study was not sufficient enough to properly predict the patient's outcome. Follow-up STEs showed new sites of myocardial involvement despite the absence of eosinophilia. CONCLUSION The use of STE in this patient, proved to have an added value in the evaluation and stratification of the left ventricular function in patients with EM and can be used as a diagnostic adjunct to CMR for diagnosis of EM.
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Affiliation(s)
- Mohammadbagher Sharifkazemi
- grid.412571.40000 0000 8819 4698Department of Cardiology, Nemazee Hospital, Shiraz University of Medical Sciences, Nemazee Square, Shiraz, 71936-13311 Iran
| | - Gholamreza Rezaian
- grid.412571.40000 0000 8819 4698Department of Cardiology, Nemazee Hospital, Shiraz University of Medical Sciences, Nemazee Square, Shiraz, 71936-13311 Iran
| | - Mehrzad Lotfi
- grid.412571.40000 0000 8819 4698Department of Radiology, Shahid Faghihi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
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11
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Fakadej T, Hathaway QA, Balar AB, Amin MS, Lakhani DA, Kim C. Eosinophilic myocarditis: Case report and brief review of the literature. Radiol Case Rep 2023; 18:306-311. [PMID: 36388617 PMCID: PMC9664397 DOI: 10.1016/j.radcr.2022.10.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 10/06/2022] [Accepted: 10/12/2022] [Indexed: 11/11/2022] Open
Abstract
Eosinophilic myocarditis (EM) is a cardiac manifestation of hypereosinophilic syndrome with a high mortality rate. EM shares imaging features similar to other restrictive cardiopathies, and include patchy intramural late gadolinium enhancement on cardiac magnetic resonance with or without presence of biventricular thrombus. Diagnosis is confirmed on histopathology, and is the current gold standard. Here we report clinical presentation and imaging findings of EM in a 70-year-old woman who presented with fever and chills.
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12
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Abete R, Valastro P, Iacovoni A, Vittori C, Arbustini E, Pellicioli F, Schiavo A, Grazioli LSC, Lorini FL, Senni M. Acute necrotizing eosinophilic myocarditis presenting with cardiogenic shock after mRNA booster dose for COVID-19: Case report and review of literature. J Cardiol Cases 2022; 27:52-55. [PMID: 36788951 PMCID: PMC9911929 DOI: 10.1016/j.jccase.2022.10.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 09/06/2022] [Accepted: 09/26/2022] [Indexed: 01/19/2023] Open
Affiliation(s)
- Raffaele Abete
- Dipartimento Cardiovascolare, ASST Papa Giovanni XXIII, Bergamo, Italy,Corresponding author at: Piazza OMS 1, 24127 Bergamo (BG), Italy.
| | - Pietro Valastro
- Dipartimento Emergenza Urgenza e Area Critica, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Attilio Iacovoni
- Dipartimento Cardiovascolare, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Claudia Vittori
- Dipartimento Cardiovascolare, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Eloisa Arbustini
- Centro Malattie Genetiche Cardiovascolari, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Federica Pellicioli
- Dipartimento Emergenza Urgenza e Area Critica, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Alessandra Schiavo
- Divisione di Cardiologia, Dipartimento di Scienze Mediche Traslazionali, Università degli Studi della Campania “Luigi Vanvitelli”, Napoli, Italy
| | | | | | - Michele Senni
- Dipartimento Cardiovascolare, ASST Papa Giovanni XXIII, Bergamo, Italy
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13
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Eosinophilic Myocarditis: An Often-Overlooked Diagnosis in Patients Presenting with Heart Failure. Case Rep Cardiol 2022; 2022:8453581. [PMID: 35813079 PMCID: PMC9270166 DOI: 10.1155/2022/8453581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 05/28/2022] [Accepted: 05/30/2022] [Indexed: 11/27/2022] Open
Abstract
Introduction. Hypereosinophilic syndrome (HES) is a rare disease characterized by unexplained peripheral eosinophilia along with evidence of end-organ damage. Cardiac involvement is the most life-threatening consequence and is frequently underreported with a prevalence of around 5%. The gold standard for diagnosis is myocardial biopsy, but less-invasive imaging such as cardiac MR (CMR) has been frequently used to help with the diagnosis. We are presenting a unique case of a patient diagnosed with Eosinophilic myocarditis (EM) supported by CMR with rapid improvement after starting steroid treatment. Case Presentation. A 67-year-old African American female with extensive cardiovascular disease history presenting with chest pain was diagnosed with EM secondary to hypereosinophilic syndrome (HES). Lab workup revealed absolute eosinophils of 4.70 × 103/μL (normal 0–0.75 × 103/μL). Transthoracic echocardiography showed mild reduction in left ventricular function and a large obliterating thrombus in the right ventricular apex. CMR showed increased signal intensity at the left ventricular and right ventricular apex, consistent with myocardial edema. Subsequently, the patient was placed on dexamethasone 10 mg daily with significant symptomatic improvement. Discussion. EM is a rare complication of hypereosinophilic syndrome and can mimic common cardiovascular diseases such as acute exacerbation of heart failure or myocardial infarction. A high index of suspicion is essential especially in the setting of suggestive lab workup. CMR is a promising noninvasive and cost-effective alternative for myocardial biopsy in diagnosis.
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14
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Si J, Zhang X, Chen N, Sun F, Du P, Li Z, Tian D, Sun X, Sun G, Cong T, Du X, Liu Y. Case Report: Multimodal Imaging Guides the Management of an Eosinophilic Leukemia Patient With Eosinophilic Myocarditis and Intracardiac Thrombus. Front Cardiovasc Med 2022; 9:903323. [PMID: 35722086 PMCID: PMC9204136 DOI: 10.3389/fcvm.2022.903323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 05/17/2022] [Indexed: 11/23/2022] Open
Abstract
Background Eosinophilic leukemia (EL) is a rare, serious and potentially life-threatening condition characterized by the overproduction of eosinophils leading to tissue eosinophilic infiltration and damage. Although multiple organ systems may be involved, progressive eosinophilic myocarditis (EM) is the most common cause of morbidity and mortality. Early diagnosis and follow-up surveillance combined with multimodal imaging are crucial for appropriate treatment of EM. Case Summary It’s a rare case of EL with EM and intracardiac thrombus in a 59-year-old patient who presented with asthenia for 3 weeks. Full blood count analysis indicated significant eosinophilia. Bone marrow aspirate revealed dysplastic eosinophilia and a FIP1L1-PDGFRA fusion gene (4q12) was detected, confirming EL. Echocardiography revealed EM with intracardiac thrombus. This was later confirmed by cardiac magnetic resonance imaging. The patient was commenced on imatinib and prednisolone and good clinical response was obtained. Through 18F-FAPI PET/CT imaging, we obtained in vivo visualization of fibroblast activation changes in the early stage of cardiac structure remodeling. With anti-fibrotic therapy after heart failure, the patient achieved a good clinical response. Conclusion This case demonstrates in vivo visualization of fibroblast activation after EM. Multimodality imaging can provide early diagnosis and may guide tailored antifibrotic therapy in early stage of EM.
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Affiliation(s)
- Jinping Si
- Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Xinxin Zhang
- Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Na Chen
- Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Fangfang Sun
- Department of Nuclear Medicine, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Ping Du
- Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Zhiyong Li
- Department of Radiology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Di Tian
- Department of Radiology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Xiuli Sun
- Department of Hematology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Guozhen Sun
- Department of Hematology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Tao Cong
- Department of Ultrasonography, First Affiliated Hospital of Dalian Medical University, Dalian, China
- *Correspondence: Tao Cong,
| | - Xuemei Du
- Department of Nuclear Medicine, First Affiliated Hospital of Dalian Medical University, Dalian, China
- Xuemei Du,
| | - Ying Liu
- Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, China
- Ying Liu,
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15
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Nassereddine Z, Charif F, Najjar C, Neghawi Z, Saab M. Eosinophilic Myocarditis: A Challenging Diagnosis. Cureus 2022; 14:e24371. [PMID: 35611032 PMCID: PMC9124442 DOI: 10.7759/cureus.24371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/22/2022] [Indexed: 11/17/2022] Open
Abstract
Eosinophilic myocarditis (EM) is a rare subtype of myocarditis that is characterized by eosinophilic infiltration of the myocardium and is associated with peripheral eosinophilia in most cases. The diagnosis is suspected in the presence of acute myocarditis and peripheral eosinophilia and is usually confirmed by endomyocardial biopsy (EMB) before starting steroid therapy. Here, we present a case of severe idiopathic eosinophilic myocarditis in a young man with a history of asthma and peripheral eosinophilia. He was treated with high-dose steroids despite negative EMB, and we noted a dramatic improvement in cardiac function. Our case highlights the importance of cardiac magnetic resonance (CMR) and clinical judgment in establishing the diagnosis of EM irrespective of the histopathologic result.
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16
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Kravchenko D, Isaak A, Mesropyan N, Endler C, Bischoff L, Vollbrecht T, Pieper CC, Sedaghat A, Kuetting D, Hart C, Feisst A, Attenberger U, Luetkens JA. Cardiac MRI in Suspected Acute Myocarditis After COVID-19 mRNA Vaccination. ROFO-FORTSCHR RONTG 2022; 194:1003-1011. [PMID: 35272355 DOI: 10.1055/a-1752-0951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE To evaluate cardiac MRI characteristics in patients with suspected hypersensitivity myocarditis following mRNA COVID-19 vaccination. MATERIALS AND METHODS Patients clinically suspected of acute myocarditis after COVID-19 vaccination were retrospectively analyzed and compared against a healthy control group. Cardiac MRI protocol included parameters such as T1 and T2 relaxation times, extracellular volume (ECV), T2 signal intensity ratio, and late gadolinium enhancement (LGE). Lymph node size was assessed in the patient group on the injection side. Student t-test, analyses of variance (ANOVA) with Tukey post-hoc test, and χ2 test were used for statistical analysis. RESULTS 20 patients with clinically suspected post-vaccine myocarditis (28 ± 12 years; 12 men) and 40 controls (31 ± 11 years; 25 men) were evaluated. According to the 2018 Lake Louise criteria (LLC), patients with clinically suspected myocarditis were further subdivided into an LLC-positive group (n = 9) and an LLC-negative group (n = 11). The mean time of symptom onset after vaccination was 1.1 ± 1.2 days (LLC-positive) and 6.5 ± 9.2 days (LLC-negative). Group differences in inflammatory variables between myocarditis patients and control subjects were more pronounced in the LLC-positive group (e. g., T1 relaxation time: 1041 ± 61 ms [LLC positive] vs. 1008 ± 79 ms [LLC-negative] vs. 970 ± 25 ms [control]; p <.001; or T2 signal intensity ratio 2.0 ± 0.3 vs. 1.6 ± 0.3 [LLC-negative] and vs. 1.6 ± 0.3 [control], p = .012). LLC-positive patients were significantly faster in receiving an MRI after initial symptom onset (8.8 ± 6.1 days vs. 52.7 ± 33.4 days; p = .001) and had higher troponin T levels (3938 ± 5850 ng/l vs. 9 ± 11 ng/l; p <.001). LGE lesions were predominantly located at the subepicardium of the lateral wall. Axillary lymphadenopathy was more frequent in the LLC-positive group compared to the LLC-negative group (8/9 [89 %] vs. 0/11 [0 %], p < 0.001). CONCLUSION Vaccine-induced myocarditis should be considered in patients with acute symptom onset after mRNA vaccination, especially if elevated serum troponin T is observed. Imaging findings of vaccine-induced myocarditis are similar to virus-induced myocarditis, allowing for the use of the Lake Louise Criteria for diagnostic purposes. KEY POINTS · Vaccine-induced hypersensitivity myocarditis can be confirmed with cardiac MRI. · Especially patients with sudden onset of symptoms and elevated serum troponin T had positive cardiac MRI findings. · Cardiac MRI characteristics of vaccine-induced myocarditis are similar to those in virus-induced myocarditis. CITATION FORMAT · Kravchenko D, Isaak A, Mesropyan N et al. Cardiac MRI in Suspected Acute Myocarditis After COVID-19 mRNA Vaccination. Fortschr Röntgenstr 2022; DOI: 10.1055/a-1752-0951.
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Affiliation(s)
- Dmitrij Kravchenko
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Germany
| | - Alexander Isaak
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Germany
| | - Narine Mesropyan
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Germany
| | - Christoph Endler
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Germany
| | - Leon Bischoff
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Germany
| | - Thomas Vollbrecht
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Germany
| | - Claus Christian Pieper
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Germany
| | - Alexander Sedaghat
- Cardiology, University Hospital Bonn Clinic II of Cardiology Angiology and Pulmonology, Bonn, Germany
| | - Daniel Kuetting
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Germany
| | - Christopher Hart
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Germany.,Department of Pediatric Cardiology, Paediatric Heart Center, University Hospital Bonn, Germany
| | - Andreas Feisst
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Germany
| | - Ulrike Attenberger
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Germany
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17
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Jain V, Bansal A, Aggarwal D, Chetrit M, Gupta M, Bhatia K, Thakkar S, Doshi R, Ghosh R, Bandopadhyay D, Barzilai B, Shiau CJ, Frishman WH, Aronow WS. Eosinophilic Myocarditis: When Allergies Attack the Heart! Cardiol Rev 2022; 30:70-74. [PMID: 34369408 DOI: 10.1097/crd.0000000000000373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Eosinophilic myocarditis is a clinical condition whereby myocardial injury is mediated by eosinophilic infiltration. A number of underlying causes, including reactive, clonal, or idiopathic hypereosinophilic syndrome, may trigger eosinophilia. Disease presentation may vary from mild subclinical variants to fulminant myocarditis with thromboembolic complications, and in some cases, endomyocardial and valvular fibrosis may be seen. A detailed examination coupled with the use of multimodality imaging, and endomyocardial biopsy may help establish diagnosis. Treatment is aimed at symptomatic management and treating the underlying cause of eosinophilia, such as withdrawal of implicated drugs, antihelminthic therapy for infection, immunosuppression for autoimmune conditions, and targeted therapy with tyrosine kinase inhibitors in cases with clonal myeloid disorders.
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Affiliation(s)
- Vardhmaan Jain
- From the Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, OH
| | - Agam Bansal
- From the Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, OH
| | - Devika Aggarwal
- Department of Internal Medicine, Beaumont Hospital, Royal Oak, MI
| | - Michael Chetrit
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, OH
| | - Manasvi Gupta
- Department of Internal Medicine, University of Connecticut Health, Farmington, CT
| | - Kirtipal Bhatia
- Department of Internal Medicine, St. Luke Roosevelt Medical Centre/Mount Sinai, New York, NY
| | | | - Rajkumar Doshi
- Department of Internal Medicine, University of Nevada Reno School of Medicine, Reno, NV
| | - Raktim Ghosh
- Department of Cardiovascular Medicine, Medstar Heart and Vascular Institute, Baltimore, MD
| | | | - Benico Barzilai
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, OH
| | - Carolyn Jane Shiau
- Department of Pathology, Royal Columbian Hospital, New Westminster, BC, Canada
| | - William H Frishman
- Department of Medicine and Cardiology, New York Medical College/Westchester Medical Center, Valhalla, NY
| | - Wilbert S Aronow
- Department of Medicine and Cardiology, New York Medical College/Westchester Medical Center, Valhalla, NY
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18
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Huynh R, Sy RW, Wong SJ, Wong CCY. A unique case report of relapsing eosinophilic myocarditis causing atrial myopathy and persistent sinus arrest. Eur Heart J Case Rep 2022; 6:ytac047. [PMID: 35233495 PMCID: PMC8874821 DOI: 10.1093/ehjcr/ytac047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 10/02/2021] [Accepted: 01/26/2022] [Indexed: 11/12/2022]
Abstract
Background Eosinophilic myocarditis (EM) is a rare and devastating condition. The underlying cause of EM is unknown, and the natural history is not well understood. Case summary A 20-year-old male presented in cardiogenic shock with preceding 24-h history of pleuritic chest pain associated with nausea and vomiting. Electrocardiogram showed sinus tachycardia with widespread ST elevation, significantly raised high-sensitivity troponin T, and raised white cell count with eosinophilia. Transthoracic echocardiogram demonstrated severe left ventricular (LV) impairment and a moderate-sized pericardial effusion. Right ventricular (RV) endomyocardial biopsy and bone marrow biopsy were performed, with both demonstrating prominent eosinophilia. He was initiated on pulse methylprednisolone leading to rapid clinical improvement with normalization of LV function. Day 9 after discharge, he was readmitted to hospital with presyncope and right heart failure. Electrocardiogram revealed junctional escape rhythm, and cardiac magnetic resonance imaging showed scarring confined to the atria. The patient was treated with mepolizumab and underwent an electrophysiology study with electroanatomical mapping, demonstrating sinus arrest and the absence of electrical activity throughout the right atrium. After much deliberation, an implantable cardioverter-defibrillator was implanted with a deep septal RV pacing lead and an apical RV defibrillator lead. Discussion We present a unique case of EM with two distinct phases: the first marked by severe LV impairment resolving with immunosuppression; the second characterized by atrial cardiomyopathy leading to persistent symptomatic sinus arrest necessitating permanent pacing. Close follow-up of EM after initial remission is essential to monitor for further complications including heart failure and arrhythmias.
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Affiliation(s)
- Ronald Huynh
- Department of Cardiology, Concord Repatriation General Hospital, 1 Hospital Rd, Concord West, Sydney, New South Wales 2139, Australia
| | - Raymond W Sy
- Department of Cardiology, Concord Repatriation General Hospital, 1 Hospital Rd, Concord West, Sydney, New South Wales 2139, Australia.,Department of Cardiology, Royal Prince Alfred Hospital, 50 Missenden Rd, Camperdown, Sydney, NSW 2050, Australia.,Faculty of Medicine and Health, University of Sydney, Science Rd, Camperdown, Sydney, NSW 2050, Australia
| | - Stephen J Wong
- Department of Pathology, St Vincent's Hospital, 390 Victoria St, Darlinghurst, Sydney, NSW 2010 Australia
| | - Christopher C Y Wong
- Department of Cardiology, Concord Repatriation General Hospital, 1 Hospital Rd, Concord West, Sydney, New South Wales 2139, Australia.,Faculty of Medicine and Health, University of Sydney, Science Rd, Camperdown, Sydney, NSW 2050, Australia
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19
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Radovanovic M, Jevtic D, Calvin AD, Petrovic M, Paulson M, Rueda Prada L, Sprecher L, Savic I, Dumic I. "Heart in DRESS": Cardiac Manifestations, Treatment and Outcome of Patients with Drug Reaction with Eosinophilia and Systemic Symptoms Syndrome: A Systematic Review. J Clin Med 2022; 11:jcm11030704. [PMID: 35160164 PMCID: PMC8836915 DOI: 10.3390/jcm11030704] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 01/17/2022] [Accepted: 01/25/2022] [Indexed: 02/07/2023] Open
Abstract
Cardiac involvement in drug reaction with eosinophilia and systemic symptoms (DS) is rare but associated with high mortality. The aim of this research was to systematically review case reports by PRISMA guidelines in order to synthetize the knowledge of cardiac manifestations of DS. We identified 42 cases from 36 case reports. Women were two times more affected than men. Two-thirds of patients had cardiac manifestation in the initial phase of the disease, while in one-third of cases cardiac manifestations developed later (mean time of 70 ± 63 days). The most common inciting medications were minocycline (19%) and allopurinol (12%). In 17% of patients, the heart was the only internal organ affected, while the majority (83%) had at least one additional organ involved, most commonly the liver and the kidneys. Dyspnea (55%), cardiogenic shock (43%), chest pain (38%), and tachycardia (33%) were the most common cardiac signs and symptoms reported. Patients frequently had an abnormal ECG (71.4%), and a decrease in left ventricular ejection fraction was the most common echocardiographic finding (45%). Endomyocardial biopsy or histological examination at autopsy was performed in 52.4%, with the predominant finding being fulminant eosinophilic myocarditis with acute necrosis in 70% of those biopsied. All patients received immunosuppressive therapy with intravenous steroids, while non-responders were more likely to have received IVIG, cyclosporine, mycophenolate, and other steroid-sparing agents (60%). Gender and degree of left ventricular systolic dysfunction were not associated with outcomes, but short latency between drug exposure and the first DRESS symptom onset (<15 days) and older age (above 65 years) was associated with death. This underscores the potential importance of heightened awareness and early treatment.
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Affiliation(s)
- Milan Radovanovic
- Mayo Clinic Alix School of Medicine, Rochester, MN 55905, USA; (M.R.); (A.D.C.); (M.P.); (L.R.P.); (L.S.)
- Department of Hospital Medicine, Mayo Clinic Health System, Eau Claire, WI 54703, USA
| | - Djordje Jevtic
- School of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (D.J.); (I.S.)
| | - Andrew D. Calvin
- Mayo Clinic Alix School of Medicine, Rochester, MN 55905, USA; (M.R.); (A.D.C.); (M.P.); (L.R.P.); (L.S.)
- Department of Cardiovascular Medicine, Mayo Clinic Health System, Eau Claire, WI 54703, USA
| | - Marija Petrovic
- Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA;
| | - Margaret Paulson
- Mayo Clinic Alix School of Medicine, Rochester, MN 55905, USA; (M.R.); (A.D.C.); (M.P.); (L.R.P.); (L.S.)
- Department of Hospital Medicine, Mayo Clinic Health System, Eau Claire, WI 54703, USA
| | - Libardo Rueda Prada
- Mayo Clinic Alix School of Medicine, Rochester, MN 55905, USA; (M.R.); (A.D.C.); (M.P.); (L.R.P.); (L.S.)
- Department of Hospital Medicine, Mayo Clinic Health System, Eau Claire, WI 54703, USA
| | - Lawrence Sprecher
- Mayo Clinic Alix School of Medicine, Rochester, MN 55905, USA; (M.R.); (A.D.C.); (M.P.); (L.R.P.); (L.S.)
- Department of Hospital Medicine, Mayo Clinic Health System, Eau Claire, WI 54703, USA
| | - Ivana Savic
- School of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (D.J.); (I.S.)
| | - Igor Dumic
- Mayo Clinic Alix School of Medicine, Rochester, MN 55905, USA; (M.R.); (A.D.C.); (M.P.); (L.R.P.); (L.S.)
- Department of Hospital Medicine, Mayo Clinic Health System, Eau Claire, WI 54703, USA
- Correspondence:
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20
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Hajra A, Gupta M, Ghosh B, Ashish K, Patel N, Manek G, Rai D, Sreenivasan J, Goel A, Lavie CJ, Bandyopadhyay D. Proposed Pathogenesis, Characteristics, and Management of COVID-19 mRNA Vaccine-Related Myopericarditis. Am J Cardiovasc Drugs 2022; 22:9-26. [PMID: 34817850 PMCID: PMC8612108 DOI: 10.1007/s40256-021-00511-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/19/2021] [Indexed: 12/21/2022]
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the novel coronavirus causing coronavirus disease 2019 (COVID-19), has affected human lives across the globe. On 11 December 2020, the US FDA granted an emergency use authorization for the first COVID-19 vaccine, and vaccines are now widely available. Undoubtedly, the emergence of these vaccines has led to substantial relief, helping alleviate the fear and anxiety around the COVID-19 illness for both the general public and clinicians. However, recent cases of vaccine complications, including myopericarditis, have been reported after administration of COVID-19 vaccines. This article discusses the cases, possible pathogenesis of myopericarditis, and treatment of the condition. Most cases were mild and should not yet change vaccine policies, although prospective studies are needed to better assess the risk-benefit ratios in different groups.
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Affiliation(s)
- Adrija Hajra
- Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY USA
| | | | - Binita Ghosh
- Burdwan Medical College, Burdwan, West Bengal India
| | - Kumar Ashish
- Crozer-Chester Medical Center, Upland, PA 19013 USA
| | | | - Gaurav Manek
- Department of Internal Medicine, University of Connecticut, Farmington, CT USA
| | - Devesh Rai
- Rochester General Hospital, Rochester, NY USA
| | | | - Akshay Goel
- New York Medical College at Westchester Medical Center, New York, NY USA
| | - Carl J. Lavie
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School-the University of Queensland School of Medicine, New Orleans, LA USA
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21
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Aota H, Yamamoto H, Isogai J, Imanaka-Yoshida K, Hiroe M, Tanaka T. Case Report: Acute Eosinophilic Myocarditis With a Low-Flow Heart Failure With Preserved Ejection Fraction Phenotype. Front Cardiovasc Med 2021; 8:678973. [PMID: 34250040 PMCID: PMC8260850 DOI: 10.3389/fcvm.2021.678973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 05/31/2021] [Indexed: 11/30/2022] Open
Abstract
Eosinophilic myocarditis is a rare subtype of myocarditis characterized by myocardial eosinophilic infiltration, and it is potentially fatal if left untreated. Although endomyocardial biopsy (EMB) is a cornerstone for the histological diagnosis of acute eosinophilic myocarditis (AEM), as it is an invasive procedure and has a low diagnostic accuracy, the diagnosis of AEM with hemodynamic instability remains challenging. We describe a case of AEM presenting as low-flow heart failure with preserved ejection fraction (HFpEF), with rapid progression to cardiogenic shock. The constellation of peripheral eosinophilia, increased left ventricular wall thickness, and HFpEF raised the suspicion of AEM. Contrast-enhanced computed tomography (CT) scan revealed heterogeneous hypoenhancement localized in the basal-to-mid septal and mid anterolateral walls of the left ventricle, strongly suggestive of acute inflammation. Based upon these findings, we performed CT-guided EMB, which lead to a definitive diagnosis. Subsequent high-dose corticosteroids allowed a rapid and dramatic recovery and normalization of cardiac structure and function. This case highlights the clinical importance of assessing AEM as a rare cause of HFpEF and the usefulness of CT-guided EMB in patients with hemodynamic instability.
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Affiliation(s)
- Hiroto Aota
- Department of Cardiology, Cardiovascular Center, Showa General Hospital, Tokyo, Japan
| | - Hiroyuki Yamamoto
- Department of Cardiology, Cardiovascular Center, Showa General Hospital, Tokyo, Japan.,Department of Cardiovascular Medicine, Narita-Tomisato Tokushukai Hospital, Chiba, Japan
| | - Jun Isogai
- Department of Radiology, Asahi General Hospital, Asahi, Japan
| | - Kyoko Imanaka-Yoshida
- Department of Pathology and Matrix Biology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Michiaki Hiroe
- Department of Cardiology, National Center for Global and Medicine, Tokyo, Japan
| | - Takahiro Tanaka
- Department of Cardiology, Cardiovascular Center, Showa General Hospital, Tokyo, Japan
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22
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Dimitroglou Y, Alexopoulos T, Aggeli C, Kalantzi M, Nouli A, Dourakis SP, Tsioufis K. Eosinophilic Myocarditis in a Patient With Strongyloides stercoralis Infection. JACC Case Rep 2021; 3:954-959. [PMID: 34317664 PMCID: PMC8311260 DOI: 10.1016/j.jaccas.2021.04.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 03/31/2021] [Accepted: 04/09/2021] [Indexed: 11/23/2022]
Abstract
A 40-year-old woman with a pulmonary embolism, central nervous system infarcts, and eosinophilia was referred for evaluation. Findings on echocardiography and cardiac magnetic resonance were consistent with eosinophilic myocarditis with left ventricular involvement. Further examination led to the diagnosis of Strongyloides stercoralis infection, and treatment with ivermectin and rivaroxaban resulted in clinical, laboratory, and cardiac imaging improvement. (Level of Difficulty: Intermediate.).
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Affiliation(s)
- Yannis Dimitroglou
- First Department of Cardiology, National and Kapodistrian University of Athens Medical School, Hippocration General Hospital of Athens, Athens, Greece
| | - Thodoris Alexopoulos
- Second Department of Internal Medicine, National and Kapodistrian University of Athens Medical School, Hippocration General Hospital of Athens, Athens, Greece
| | - Constantina Aggeli
- First Department of Cardiology, National and Kapodistrian University of Athens Medical School, Hippocration General Hospital of Athens, Athens, Greece
| | - Maria Kalantzi
- Department of Cardiology and Cardiac Magnetic Resonance, IASO Hospital, Athens, Greece
| | - Anastasia Nouli
- Department of Cardiology, Andreas Papandreou General Hospital of Rhodes, Rhodes, Greece
| | - Spyridon P. Dourakis
- Second Department of Internal Medicine, National and Kapodistrian University of Athens Medical School, Hippocration General Hospital of Athens, Athens, Greece
| | - Konstantinos Tsioufis
- First Department of Cardiology, National and Kapodistrian University of Athens Medical School, Hippocration General Hospital of Athens, Athens, Greece
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23
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Hoppens KR, Alai HR, Surla J, Khokhar HO, Hendel RC. Fulminant Eosinophilic Myocarditis and VT Storm. JACC Case Rep 2021; 3:474-478. [PMID: 34317561 PMCID: PMC8311013 DOI: 10.1016/j.jaccas.2020.12.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 11/12/2020] [Accepted: 12/02/2020] [Indexed: 01/05/2023]
Abstract
Eosinophilic myocarditis is a rare and frequently fatal disease that is often undiagnosed until autopsy. We report a case of eosinophilic myocarditis with an unusual initial presentation of palpitations that subsequently evolved into ventricular tachycardia storm and death within 4 days. (Level of Difficulty: Beginner.).
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Affiliation(s)
- Kyle R. Hoppens
- Department of Internal Medicine, Louisiana State University, New Orleans, Louisiana, USA
| | - Hamid R. Alai
- Section of Cardiology, Tulane University, New Orleans, Louisiana, USA
| | - Jelena Surla
- Department of Internal Medicine, Louisiana State University, New Orleans, Louisiana, USA
| | - Hina O. Khokhar
- Department of Pathology, Louisiana State University, New Orleans, Louisiana, USA
| | - Robert C. Hendel
- Section of Cardiology, Tulane University, New Orleans, Louisiana, USA
- Address for correspondence: Dr. Robert C. Hendel, Tulane University, Section of Cardiology, 1430 Tulane Avenue, Suite 7550, New Orleans, Louisiana 70112,USA.
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24
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Case Report of Fulminant Eosinophilic Myocarditis With Concomitant Pheochromocytoma. A A Pract 2021; 15:e01348. [PMID: 33560641 DOI: 10.1213/xaa.0000000000001348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
A 33-year-old woman presented with fulminant eosinophilic myocarditis requiring venoarterial extracorporeal membrane oxygenation (ECMO). A computed tomography (CT) scan revealed a retroperitoneal mass that was eventually diagnosed as a pheochromocytoma. This case highlights the need for a comprehensive diagnostic workup for acute cardiomyopathy manifesting as cardiogenic shock in young patients and the benefit of early initiation of mechanical support facilitating both diagnosis and recovery.
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25
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Marcolongo R, Rizzo S, Cerutti A, Reffo E, Castaldi B, Baritussio A, Basso C, Di Salvo G, Caforio AL. The multiple faces of autoimmune/immune-mediated myocarditis in children: a biopsy-proven case series treated with immunosuppressive therapy. ESC Heart Fail 2021; 8:1604-1609. [PMID: 33452872 PMCID: PMC8006650 DOI: 10.1002/ehf2.13163] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 11/13/2020] [Accepted: 11/20/2020] [Indexed: 12/23/2022] Open
Abstract
The role of immunosuppressive therapy (IT) in paediatric autoimmune/immune‐mediated myocarditis remains poorly defined. To explore its role, we present a series of three consecutive paediatric patients with biopsy‐proven, virus negative, autoimmune/immune‐mediated myocarditis, with distinct clinical and pathological features, who have been successfully treated with IT, a 14‐year‐old boy with Loeffler's fibroblastic parietal endomyocarditis, a 6‐year‐old child with celiac disease with chronic active lymphocytic myocarditis, and a 13‐year‐old boy with long‐standing heart failure and active lymphocytic myocarditis. Patients started IT and entered follow‐up between July 2017 and September 2019; the first patient completed IT. IT was associated with a substantial and sustained recovery of cardiac function in our patients, regardless of their heterogeneous clinical and pathological features. Combination IT was well tolerated and enabled tapering and weaning off steroids.
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Affiliation(s)
- Renzo Marcolongo
- Hematology and Clinical Immunology, Department of MedicineUniversity of PadovaPadovaItaly
| | - Stefania Rizzo
- Cardiovascular Pathology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public HealthUniversity of PadovaPadovaItaly
| | - Alessia Cerutti
- Pediatric Cardiology, Department of Woman and Child HealthUniversity of PadovaPadovaItaly
| | - Elena Reffo
- Pediatric Cardiology, Department of Woman and Child HealthUniversity of PadovaPadovaItaly
| | - Biagio Castaldi
- Pediatric Cardiology, Department of Woman and Child HealthUniversity of PadovaPadovaItaly
| | - Anna Baritussio
- Division of Cardiology, Department of Cardiac Thoracic Vascular Sciences and Public HealthUniversity of PadovaPadovaItaly
| | - Cristina Basso
- Cardiovascular Pathology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public HealthUniversity of PadovaPadovaItaly
| | - Giovanni Di Salvo
- Pediatric Cardiology, Department of Woman and Child HealthUniversity of PadovaPadovaItaly
| | - Alida L.P. Caforio
- Division of Cardiology, Department of Cardiac Thoracic Vascular Sciences and Public HealthUniversity of PadovaPadovaItaly
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26
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Bohné M, Chung DU, Tigges E, van der Schalk H, Waddell D, Schenker N, Willems S, Klingel K, Kivelitz D, Bahlmann E. Short-term use of "ECMELLA" in the context of fulminant eosinophilic myocarditis with cardiogenic shock. BMC Cardiovasc Disord 2020; 20:519. [PMID: 33302874 PMCID: PMC7731477 DOI: 10.1186/s12872-020-01808-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 12/02/2020] [Indexed: 12/18/2022] Open
Abstract
Background Eosinophilic myocarditis (EM) is a rare form of myocarditis. Clinical presentation is various, includes cardiogenic shock and can often be fatal. Diagnosis is based on myocardial eosinophilic infiltration in endomyocardial biopsy. Mechanical circulatory support (MCS) is often required in patients suffering from severe cardiogenic shock. Among the available MCS options the “ECMELLA” concept, a combination of left ventricular venting by Impella® device and extracorporeal life support (ECLS) is possibly able to provide the necessary time frame for diagnostics and initiation of anti-inflammatory medication in patients with fulminant myocarditis.
Case presentation We report a case of a 38‐year‐old woman who was presented to us in severe cardiogenic shock, quickly requiring hemodynamic support by an Impella CP® device. Further dramatic hemodynamic deterioration accompanied by multi-organ dysfunction required escalation of MCS via ECLS as veno‐arterial extracorporeal membrane oxygenation (VA-ECMO). After histopathological diagnosis of EM, our patient was put on immunosuppressive therapy with prednisolone. Recovery of both right and left ventricular function allowed explanation of VA-ECMO on day 4 and further hemodynamic improvement allowed removal of the Impella® device on day 9. The patient was discharged after 7 weeks with fully restored cardiac function and in a good neurological state. Conclusions In severe cardiac shock due to fulminant EM the ECMELLA concept as bridge-to-recovery seems to be a valid option to provide the required time for diagnostics and specific therapy.
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Affiliation(s)
- Mintje Bohné
- Department of Cardiology, Asklepios Clinic St. Georg, Lohmühlenstraße 5, 20099, Hamburg, Germany
| | - Da-Un Chung
- Department of Cardiology, Asklepios Clinic St. Georg, Lohmühlenstraße 5, 20099, Hamburg, Germany
| | - Eike Tigges
- Department of Cardiology, Asklepios Clinic St. Georg, Lohmühlenstraße 5, 20099, Hamburg, Germany
| | - Hendrick van der Schalk
- Department of Cardiology, Asklepios Clinic St. Georg, Lohmühlenstraße 5, 20099, Hamburg, Germany
| | - Daniela Waddell
- Department of Cardiology, Asklepios Clinic St. Georg, Lohmühlenstraße 5, 20099, Hamburg, Germany
| | - Niklas Schenker
- Department of Cardiology, Asklepios Clinic St. Georg, Lohmühlenstraße 5, 20099, Hamburg, Germany
| | - Stephan Willems
- Department of Cardiology, Asklepios Clinic St. Georg, Lohmühlenstraße 5, 20099, Hamburg, Germany
| | - Karin Klingel
- Department of Cardiopathology, Institute for Pathology, University Hospital Tübingen, Tübingen, Germany
| | - Dietmar Kivelitz
- Department of Radiology, Asklepios Clinic St. Georg, Hamburg, Germany
| | - Edda Bahlmann
- Department of Cardiology, Asklepios Clinic St. Georg, Lohmühlenstraße 5, 20099, Hamburg, Germany.
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27
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Tse YH, Chan WS, Chim CS, Tse HF. Lenalidomide-induced focal myocarditis mimicking acute ST segment elevation myocardial infarction. Postgrad Med J 2020; 97:762-763. [PMID: 33277335 PMCID: PMC8639956 DOI: 10.1136/postgradmedj-2020-139107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 10/23/2020] [Accepted: 10/29/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Yiu-Hei Tse
- LKS Faculty of Medicine, University of Hong Kong, Hong Kong, China
| | | | | | - Hung Fat Tse
- Medicine, University of Hong Kong, Hong Kong, China
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28
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Polito MV, Hagendorff A, Citro R, Prota C, Silverio A, De Angelis E, Klingel K, Metze M, Stöbe S, Hoffmann KT, Sabri O, Piscione F, Galasso G. Loeffler's Endocarditis: An Integrated Multimodality Approach. J Am Soc Echocardiogr 2020; 33:1427-1441. [PMID: 33129649 DOI: 10.1016/j.echo.2020.09.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 09/05/2020] [Accepted: 09/07/2020] [Indexed: 02/09/2023]
Abstract
Loeffler's endocarditis (LE) is the cardiac manifestation of hypereosinophilic syndrome, a rare systemic disease characterized by the sustained production of eosinophils leading to organ damage. Few data, principally by case reports, are available regarding the diagnostic workup in patients with suspected LE. Thus, we have performed a systematic search of the literature dealing with imaging in LE and propose an integrated multimodality imaging approach in the cardiac diagnostics of LE patients. The aim is to provide an updated state-of-the-art review focused on noninvasive and invasive imaging modalities for this rare and underdiagnosed disease. Standard and advanced echocardiography are typically the first cardiac imaging examinations when LE is suspected and they are also used later in follow-up for prognostic stratification and assessing response to treatment. Cardiac magnetic resonance provides a more detailed anatomical and functional evaluation of cardiac chambers, tissue characterization for the presence and extension of myocardial edema and fibrosis, and ventricular thrombi identification. Computed tomography scan and [18F]-fluoro-deoxy-glucose positron emission tomography may be helpful in selected cases to evaluate the cardiac involvement of LE as well as the other noncardiac manifestations of hypereosinophilic syndrome. Endomyocardial biopsy may be considered in patients with high clinical suspicion of LE if noninvasive imaging findings are confusing or not conclusive. The appropriate use of invasive and noninvasive imaging modalities, combining the available techniques with the patients' clinical features, will hopefully lead to early diagnosis, more accurate staging of disease, and timely treatment of LE that may prevent the irreversible myocardial damage of LE and adverse cardiovascular events.
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Affiliation(s)
- Maria Vincenza Polito
- Division of Cardiology, Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy.
| | | | - Rodolfo Citro
- Department of Cardiology, A.O.U. "San Giovanni di Dio e Ruggi D'Aragona", Salerno, Italy
| | - Costantina Prota
- Division of Cardiology, Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | - Angelo Silverio
- Division of Cardiology, Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | - Elena De Angelis
- Division of Cardiology, Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | - Karin Klingel
- Cardiopathology, Institute for Pathology and Neuropathology, University Hospital Tübingen, Tübingen, Germany
| | - Michael Metze
- Department of Cardiology, University Hospital Leipzig, Leipzig, Germany
| | - Stephan Stöbe
- Department of Cardiology, University Hospital Leipzig, Leipzig, Germany
| | | | - Osama Sabri
- Department of Nuclear Medicine, University Hospital Leipzig, Leipzig, Germany
| | - Federico Piscione
- Division of Cardiology, Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | - Gennaro Galasso
- Division of Cardiology, Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
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29
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Chen X, Zhao MZ, Miao BP, Liu ZQ, Yang G, Liu JQ, Yang PC, Song JP. Inhibition of Bcl2L12 Attenuates Eosinophilia-Related Inflammation in the Heart. Front Immunol 2020; 11:1955. [PMID: 33013849 PMCID: PMC7516035 DOI: 10.3389/fimmu.2020.01955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 07/20/2020] [Indexed: 11/25/2022] Open
Abstract
Background: The eosinophilic inflammation plays a critical role in myocarditis (Mcd); its underlying mechanism remains to be further elucidated. This study aims to investigate the role of Bcl2-like protein 12 (Bcl2L12) in inducing the defects of apoptosis in eosinophils (Eos) of the heart tissues. Methods: Human explant heart samples were collected. Eosinophilia and myocarditis (Mcd)-like inflammation were induced in the mouse heart by immunizing with murine cardiac α-myosin heavy chain (MyHCα) peptides. Results: Markedly more Eos were observed in heart tissues from patients with Mcd than those from patients with dilated cardiomyopathy. Eos isolated from Mcd hearts showed the signs of apoptosis defects. The Eo counts in the Mcd heart tissues were positively correlated with the Bcl2L12 expression in Eos isolated from the heart tissues. Exposure to interleukin 5 in the culture induced the expression of Bcl2L12 in Eos. Bcl2L12 bound c-Myc, the transcription factor of Fas ligand (FasL), to prevent c-Myc from binding to the FasL promoter, to restrict the FasL gene transcription in Eos. Inhibition of Bcl2L12 prevented the induction of eosinophilia and Mcd-like inflammation in the mouse heart. Conclusions: The Bcl2L12 expression contributes to apoptosis defects in Eos of the Mcd heart. Blocking Bcl2L12 prevents the eosinophilia induction and alleviates Mcd-like inflammation in mice.
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Affiliation(s)
- Xiao Chen
- State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Mei-Zhen Zhao
- Research Center of Allergy & Immunology, Shenzhen University School of Medicine, Shenzhen, China
| | - Bei-Ping Miao
- Department of Otolaryngology, First Affiliated Hospital of Shenzhen University, Shenzhen, China
| | - Zhi-Qiang Liu
- Research Center of Allergy & Immunology, Shenzhen University School of Medicine, Shenzhen, China
| | - Gui Yang
- Department of Otolaryngology, Longgang Central Hospital, Shenzhen, China
| | - Jiang-Qi Liu
- Research Center of Allergy & Immunology, Shenzhen University School of Medicine, Shenzhen, China
| | - Ping-Chang Yang
- Research Center of Allergy & Immunology, Shenzhen University School of Medicine, Shenzhen, China.,Guangdong Provincial Key Laboratory of Regional Immunity and Diseases, Shenzhen, China
| | - Jiang-Ping Song
- State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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30
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Buchanan CE, Kakkar E, Dreskin SC, Allen LA, Groves DW, Altman NL. Allergy and the Heart: Eosinophilic Myocarditis With Biventricular Thrombi. JACC Case Rep 2020; 2:1942-1946. [PMID: 34317085 PMCID: PMC8299133 DOI: 10.1016/j.jaccas.2020.07.046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 07/02/2020] [Accepted: 07/22/2020] [Indexed: 11/27/2022]
Abstract
A 40-year-old woman with history of atopy and peripheral eosinophilia presented with clinical signs of heart failure. Echocardiography revealed a restrictive cardiomyopathy with biventricular thrombi. Hypereosinophilic syndrome resulting in eosinophilic myocarditis (Loeffler’s syndrome) was diagnosed. This case highlights the workup, diagnosis, and management of hypereosinophilic syndrome with eosinophilic myocarditis. (Level of Difficulty: Advanced.)
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Affiliation(s)
- Cullen E Buchanan
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Ekta Kakkar
- Department of Medicine, Division of Allergy and Immunology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Stephen C Dreskin
- Department of Medicine, Division of Allergy and Immunology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Larry A Allen
- Department of Medicine-Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Daniel W Groves
- Department of Medicine-Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Natasha L Altman
- Department of Medicine-Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
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31
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Han J, Ramtoola M, Shahzad M, Okonkwo K, Attar N. Right sided heart failure secondary to hypereosinophilic cardiomyopathy - clinical manifestation and diagnostic pathway. Radiol Case Rep 2020; 15:2036-2040. [PMID: 32922583 PMCID: PMC7475079 DOI: 10.1016/j.radcr.2020.08.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 07/30/2020] [Accepted: 08/01/2020] [Indexed: 11/30/2022] Open
Abstract
Hypereosinophilic cardiomyopathy is a rare restrictive cardiomyopathy which often presents with left-sided heart failure. We present an interesting case of a 58-year-old male patient with known hypereosinophillic syndrome who had presented with congestive cardiac failure with predominant features of right-sided volume overload. Cardiac magnetic resonance imaging confirmed the diagnosis by demonstrating obliteration of the right ventricular apex and endocardial-delayed gadolinium enhancement at the mid-septal and inferior segment, at both the right ventricular and left ventricular apical region, consistent with fibrosis. He was successfully treated with intravenous diuretics to good effect. This case report demonstrates a rare clinical presentation of right ventricle involvement in hypereosinophilic cardiomyopathy and the current pathway for diagnosis with the favoured emergence of cardiac magnetic resonance imaging. All patients with hypereosinophilic syndrome should be closely monitored for signs of cardiac involvement, as early treatment carries a better prognosis.
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Affiliation(s)
- Jennie Han
- Department of Cardiology, Royal Lancaster Infirmary, NHS, Ashton Road, Lancaster, LA1 4RP United Kingdom
| | - Mohammad Ramtoola
- Department of Cardiology, Royal Lancaster Infirmary, NHS, Ashton Road, Lancaster, LA1 4RP United Kingdom
| | - Muhammad Shahzad
- Department of Cardiology, Royal Lancaster Infirmary, NHS, Ashton Road, Lancaster, LA1 4RP United Kingdom
| | - Kenneth Okonkwo
- Department of Cardiology, Royal Lancaster Infirmary, NHS, Ashton Road, Lancaster, LA1 4RP United Kingdom
| | - Nadeem Attar
- Department of Cardiology, Royal Lancaster Infirmary, NHS, Ashton Road, Lancaster, LA1 4RP United Kingdom
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32
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Kindermann M, Sood N, Ehrlich P, Klingel K. Fast spontaneous recovery from acute necrotizing eosinophilic myopericarditis without need for immunosuppressive therapy: a case report of a 27-year-old male. EUROPEAN HEART JOURNAL-CASE REPORTS 2020; 4:1-5. [PMID: 32974437 DOI: 10.1093/ehjcr/ytaa153] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Revised: 02/19/2020] [Accepted: 05/07/2020] [Indexed: 11/12/2022]
Abstract
Background Eosinophilic myocarditis (EM) is rare but accounts for 12-22% of histologically proven acute myocarditis cases. Acute necrotizing EM is considered an aggressive, life-threatening disease which is usually treated by high-dose corticosteroid therapy. Case summary We report the case of a 27-year-old man with acute severe pericarditic chest pain, moderately reduced left ventricular (LV) ejection fraction, and a small pericardial effusion. Troponin I level was highly elevated in the absence of coronary artery disease, leading to the diagnosis of acute myopericarditis. In the absence of blood eosinophilia and despite a negative cardiac magnetic resonance study, LV endomyocardial biopsy revealed an acute necrotizing EM. With conventional antiphlogistic and heart failure therapy, the patient became symptom-free and inflammatory and cardiac necrosis markers as well as LV ejection fraction normalized within days. Thus, in the absence of a systemic hypereosinophilic disorder, there was no need for steroid therapy. Long-term follow-up over 12 months showed sustained normalization of cardiac structure and function. Discussion Acute necrotizing eosinophilic myopericarditis is not always a dreadful cardiac disease. There are idiopathic cases which may quickly resolve without immunosuppression. There seems to be a publication bias towards critical cases.
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Affiliation(s)
- Michael Kindermann
- Department of Cardiology, Angiology and Pneumology, CaritasKlinikum St. Theresia, Academic teaching hospital of the Saarland University Faculty of Medicine, Rheinstr. 2, 66113 Saarbrücken, Germany
| | - Nitin Sood
- Department of Cardiology, Angiology and Pneumology, CaritasKlinikum St. Theresia, Academic teaching hospital of the Saarland University Faculty of Medicine, Rheinstr. 2, 66113 Saarbrücken, Germany
| | - Peter Ehrlich
- Department of Cardiology, Angiology and Pneumology, CaritasKlinikum St. Theresia, Academic teaching hospital of the Saarland University Faculty of Medicine, Rheinstr. 2, 66113 Saarbrücken, Germany
| | - Karin Klingel
- Department of Cardiopathology, Institute for Pathology, University Hospital Tübingen, Liebermeisterstr. 8, 72076 Tübingen, Germany
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33
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Tran N, Kwok CS, Bennett S, Ratib K, Heatlie G, Phan T. Idiopathic eosinophilic myocarditis presenting with features of an acute coronary syndrome. Echo Res Pract 2020; 7:K1-K6. [PMID: 32110421 PMCID: PMC7040860 DOI: 10.1530/erp-19-0044] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 01/09/2020] [Indexed: 01/22/2023] Open
Abstract
Summary A 62-year-old female was admitted with severe left-sided chest pain, nausea and pre-syncope. She had widespread T wave inversion on ECG and elevated troponins and was suspected to have an acute coronary syndrome event. Invasive coronary angiogram revealed normal coronary anatomy with no flow-limiting lesions. Echocardiography and cardiac MRI revealed impaired left ventricular (LV) systolic impairment, a mobile LV apical thrombus and a moderate global pericardial effusion with no significant compromise. Full blood count analysis indicated the patient to have significant eosinophilia, and the patient was diagnosed with idiopathic eosinophilic myocarditis. She was commenced on Prednisolone and Apixaban, and eosinophil levels returned to normal after 10 days of steroids. Over the course of 3 months, the patient had a complete recovery of her LV function and resolution of the LV thrombus. This case highlights a rare, reversible case of idiopathic eosinophilic myocarditis which may present similar to acute coronary syndrome. Learning points:
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Affiliation(s)
- Nam Tran
- University Hospitals of North Midlands NHS Trust, Cardiology, Stoke-on-Trent, UK
| | - Chun Shing Kwok
- University Hospitals of North Midlands, Department of Cardiology, Stoke-on-Trent, UK
| | - Sadie Bennett
- Royal Stoke University Hospital, Heart and Lung Centre, Stoke-on-Trent, UK
| | - Karim Ratib
- University Hospitals of North Midlands NHS Trust, Cardiology, Stoke-on-Trent, UK
| | - Grant Heatlie
- University Hospitals of North Midlands NHS Trust, Cardiology, Stoke-on-Trent, UK
| | - Thanh Phan
- University Hospitals of North Midlands NHS Trust, Cardiology, Stoke-on-Trent, UK
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Buttà C, Zappia L, Laterra G, Roberto M. Diagnostic and prognostic role of electrocardiogram in acute myocarditis: A comprehensive review. Ann Noninvasive Electrocardiol 2019; 25. [PMID: 31778001 PMCID: PMC7958927 DOI: 10.1111/anec.12726] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Revised: 09/28/2019] [Accepted: 10/07/2019] [Indexed: 12/21/2022] Open
Abstract
Background Acute myocarditis represents a challenging diagnosis as there is no pathognomonic clinical presentation. In patients with myocarditis, electrocardiogram (ECG) can display a variety of non‐specific abnormalities. Nevertheless, ECG is widely used as an initial screening tool for myocarditis. Methods We researched all possible ECG alterations during acute myocarditis evaluating prevalence, physiopathology, correlation with clinical presentation patterns, role in differential diagnosis, and prognostic yield. Results The most common ECG abnormality in myocarditis is sinus tachycardia associated with nonspecific ST/T‐wave changes. The presence of PR segment depression both in precordial and limb leads, a PR segment depression in leads with ST segment elevation, a PR segment elevation in aVR lead or a ST elevation with pericarditis pattern favor generally diagnosis of perimyocarditis rather than myocardial infarction. In patients with acute myocarditis, features associated with a poorer prognosis are: pathological Q wave, wide QRS complex, QRS/T angle ≥ 100°, prolonged QT interval, high‐degree atrioventricular block and malignant ventricular tachyarrhythmia. On the contrary, ST elevation with a typical early repolarization pattern is associated with a better prognosis. Conclusions ECG alterations in acute myocarditis could be very useful in clinical practice for a patient‐tailored approach in order to decide appropriate therapy, length of hospitalization, and frequency of followup.
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Affiliation(s)
- Carmelo Buttà
- Cardiology Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Luca Zappia
- Cardiology Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Giulia Laterra
- Cardiology Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Marco Roberto
- Department of Cardiology, Cardiocentro Ticino, Lugano, Switzerland
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Morgan H, Zaidi A, Anderson R, Goodfellow R, Ellis G. New breathlessness in a young patient with rheumatoid arthritis. Br J Hosp Med (Lond) 2019; 80:612-613. [PMID: 31589517 DOI: 10.12968/hmed.2019.80.10.612] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Holly Morgan
- Cardiology Registrar, Department of Cardiology, Royal Glamorgan Hospital, Llantrisant CF72 8XR
| | - Abbas Zaidi
- Cardiology Consultant, Department of Cardiology, University Hospital of Wales, Cardiff
| | - Richard Anderson
- Cardiology Consultant, Department of Cardiology, University Hospital of Wales, Cardiff
| | - Rhian Goodfellow
- Rheumatology Consultant, Department of Rheumatology, Royal Glamorgan Hospital, Llantrisant
| | - Gethin Ellis
- Cardiology Consultant, Department of Cardiology, Royal Glamorgan Hospital, Llantrisant
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Ferreira VM, Schulz-Menger J, Holmvang G, Kramer CM, Carbone I, Sechtem U, Kindermann I, Gutberlet M, Cooper LT, Liu P, Friedrich MG. Cardiovascular Magnetic Resonance in Nonischemic Myocardial Inflammation: Expert Recommendations. J Am Coll Cardiol 2019; 72:3158-3176. [PMID: 30545455 DOI: 10.1016/j.jacc.2018.09.072] [Citation(s) in RCA: 1169] [Impact Index Per Article: 233.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 09/14/2018] [Accepted: 09/25/2018] [Indexed: 11/26/2022]
Abstract
This JACC Scientific Expert Panel provides consensus recommendations for an update of the cardiovascular magnetic resonance (CMR) diagnostic criteria for myocardial inflammation in patients with suspected acute or active myocardial inflammation (Lake Louise Criteria) that include options to use parametric mapping techniques. While each parameter may indicate myocardial inflammation, the authors propose that CMR provides strong evidence for myocardial inflammation, with increasing specificity, if the CMR scan demonstrates the combination of myocardial edema with other CMR markers of inflammatory myocardial injury. This is based on at least one T2-based criterion (global or regional increase of myocardial T2 relaxation time or an increased signal intensity in T2-weighted CMR images), with at least one T1-based criterion (increased myocardial T1, extracellular volume, or late gadolinium enhancement). While having both a positive T2-based marker and a T1-based marker will increase specificity for diagnosing acute myocardial inflammation, having only one (i.e., T2-based OR T1-based) marker may still support a diagnosis of acute myocardial inflammation in an appropriate clinical scenario, albeit with less specificity. The update is expected to improve the diagnostic accuracy of CMR further in detecting myocardial inflammation.
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Affiliation(s)
- Vanessa M Ferreira
- University of Oxford Centre for Clinical Magnetic Resonance Research, John Radcliffe Hospital, Oxford, United Kingdom
| | - Jeanette Schulz-Menger
- Charité-Universitätsmedizin, Department of Cardiology and Helios-Klinikum, DZHK-Partnersite-Berlin, Germany
| | - Godtfred Holmvang
- Division of Cardiology and Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Christopher M Kramer
- Departments of Medicine (Cardiology) and Radiology, University of Virginia Health System, Charlottesville, Virginia
| | - Iacopo Carbone
- Department of Radiological, Oncological and Pathological Sciences, Sapienza, University of Rome, Rome, Italy
| | - Udo Sechtem
- Department of Cardiology, Robert-Bosch-Krankenhaus, Stuttgart, Germany
| | - Ingrid Kindermann
- Department of Internal Medicine III, Saarland University Medical Center, Homburg/Saar, Germany
| | - Matthias Gutberlet
- Department of Diagnostic and Interventional Radiology, University of Leipzig, Heart Center, Leipzig, Germany
| | | | - Peter Liu
- Ottawa Heart Institute, Ottawa, Canada
| | - Matthias G Friedrich
- Heidelberg University Hospital, Heidelberg, Germany; Department of Cardiology, McGill University Health Centre, Montreal, Canada; Department of Diagnostic Radiology, McGill University Health Centre, Montreal, Canada.
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Kassem KM, Souka A, Harris DM, Parajuli S, Cook JL. Eosinophilic Myocarditis: Classic Presentation of Elusive Disease. Circ Cardiovasc Imaging 2019; 12:e009487. [PMID: 31451002 DOI: 10.1161/circimaging.119.009487] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Kamal M Kassem
- Department of Internal Medicine (K.M.K.), University of Cincinnati Medical Center, OH
| | - Ahmed Souka
- Division of Cardiovascular Health and Disease, Department of Internal Medicine, University of Cincinnati College of Medicine, OH (A.S., D.M.H., J.L.C.)
| | - David M Harris
- Division of Cardiovascular Health and Disease, Department of Internal Medicine, University of Cincinnati College of Medicine, OH (A.S., D.M.H., J.L.C.)
| | - Shobha Parajuli
- Department of Pathology and Laboratory Medicine (S.P.), University of Cincinnati Medical Center, OH
| | - Jennifer L Cook
- Division of Cardiovascular Health and Disease, Department of Internal Medicine, University of Cincinnati College of Medicine, OH (A.S., D.M.H., J.L.C.)
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Stempfl J, Schumacher F, Doering M, Wolf H, Streithoff F, Tacke J, Fahn H, Ehlermann P, Raake P, Klingel K, Elsner D, Groebner M. [Atrioventricular block and left ventricular wall mobility disorder in a 44-year-old female patient : A case report of a rarity with pitfalls]. Internist (Berl) 2019; 60:973-981. [PMID: 31123761 DOI: 10.1007/s00108-019-0608-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Eosinophilic myocarditis is a rare condition with good treatment options, which can be difficult to diagnose. The clinical presentation can vary from asymptomatic to life-threatening forms. This article describes the case of a 44-year-old woman who suffered from vertigo, chest pain and dyspnea. The woman presented with an intermittent atrioventricular (AV) block II Mobitz type II° and mild impairment of left ventricular ejection fraction. Hypereosinophilia in the peripheral blood, cardiac magnetic resonance imaging (MRI) and endomyocardial biopsy led to the diagnosis of eosinophilic myocarditis, most likely as a result of an allergic reaction to Aspergillus fumigatus. A general treatment recommendation cannot be made due to the lack of evidence-based guidelines; however, recent scientific studies confirmed timely, high-dose steroid administration over several months to be the mainstay of treatment of eosinophilic myocarditis. The following article may be helpful in the early diagnosis and treatment of this underdiagnosed and insidious disease.
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Affiliation(s)
- J Stempfl
- 3. Medizinische Klinik, Klinik für Kardiologie, Herzzentrum, Klinikum Passau, Innstraße 76, 94032, Passau, Deutschland.
| | - F Schumacher
- 3. Medizinische Klinik, Klinik für Kardiologie, Herzzentrum, Klinikum Passau, Innstraße 76, 94032, Passau, Deutschland
| | - M Doering
- 3. Medizinische Klinik, Klinik für Kardiologie, Herzzentrum, Klinikum Passau, Innstraße 76, 94032, Passau, Deutschland
| | - H Wolf
- Institut für diagnostische und interventionelle Radiologie/Neuroradiologie, Klinikum Passau, Passau, Deutschland
| | - F Streithoff
- Institut für diagnostische und interventionelle Radiologie/Neuroradiologie, Klinikum Passau, Passau, Deutschland
| | - J Tacke
- Institut für diagnostische und interventionelle Radiologie/Neuroradiologie, Klinikum Passau, Passau, Deutschland
| | - H Fahn
- Klinik für Gastroenterologie, Hepatologie, Nephrologie, Rheumatologie und Stoffwechselerkrankungen, Klinikum Passau, Passau, Deutschland
| | - P Ehlermann
- Klinik für Kardiologie, Medizinische Universitätsklinik Heidelberg, Heidelberg, Deutschland
| | - P Raake
- Klinik für Kardiologie, Medizinische Universitätsklinik Heidelberg, Heidelberg, Deutschland
| | - K Klingel
- Kardiopathologie, Institut für Pathologie und Neuropathologie, Universitätsklinikum Tübingen, Tübingen, Deutschland
| | - D Elsner
- 3. Medizinische Klinik, Klinik für Kardiologie, Herzzentrum, Klinikum Passau, Innstraße 76, 94032, Passau, Deutschland
| | - M Groebner
- 3. Medizinische Klinik, Klinik für Kardiologie, Herzzentrum, Klinikum Passau, Innstraße 76, 94032, Passau, Deutschland
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Clozapine-Induced Cardiotoxicity Presenting as Sepsis: A Case Report and Literature Review. Case Rep Med 2019; 2019:3435108. [PMID: 31049067 PMCID: PMC6462315 DOI: 10.1155/2019/3435108] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Accepted: 03/18/2019] [Indexed: 12/15/2022] Open
Abstract
Clozapine is an atypical antipsychotic agent indicated in the treatment of medication-resistant schizophrenia. It is often reserved as a last line of treatment owing to the potential for serious and potentially life-threatening side effects, the most serious being agranulocytosis requiring close hematological monitoring and possible discontinuation of the medication from further use in the patient even when the agranulocytosis resolves. Other complications of clozapine include sedation, weight gain, elevated triglyceride levels, postural hypotension, and tachycardia. However, the potentially serious complication of myocarditis, though rare (with an incidence of 3%), may lead to cardiomyopathy as described in our present case. We present a 21-year-old patient who was started on clozapine for management of schizophrenia. He developed fever and tachycardia and was admitted to the medical unit on intravenous antibiotics for management of sepsis as he met the criteria for systemic inflammatory response syndrome. His labs revealed an elevated troponin and trending eosinophilia, which, in the context of clozapine use, raises the suspicion of clozapine cardiotoxicity. Echocardiogram showed reduced systolic function (45%). Clozapine was immediately discontinued, and his repeat echocardiogram showed normalization of his systolic function. In view of the increased prevalence of psychiatric illnesses, internists should be aware of rare but potentially life-threatening side effects.
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40
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Severe eosinophilic myocarditis associated with modafinil in a patient with normal peripheral eosinophil count. Clin Res Cardiol 2019; 108:963-966. [DOI: 10.1007/s00392-019-01434-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 02/05/2019] [Indexed: 12/28/2022]
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Abstract
Eosinophilic myocarditis is rare in children, and consequently, it is difficult to diagnose eosinophilic myocarditis rapidly. We report the clinical course of acute eosinophilic myocarditis with pericarditis in two adolescent boys and their associated electrocardiograms. The two patients, 13- and 14-year-old boys, developed cardiomegaly and chest pain with vomiting. On examination by two-dimensional echocardiography, thickening of the ventricular septum and a pericardial effusion were detected. The eosinophil count had increased by the pericardial effusion. Acute eosinophilic myocarditis often complicates a moderate to severe pericardial effusion owing to acute pericarditis. A cellular fraction analysis of the pericardial effusion is easy and useful for the diagnosis of eosinophilic myocarditis. Some serial changes in the electrocardiogram occur during each stage of acute eosinophilic myocarditis. They are induced by eosinophilic granules, which are capable of inducing tissue damage and dysfunction, and those changes in the electrocardiogram resemble the changes after an acute myocardial infarction. It is important to know the characteristics of eosinophilic myocarditis in order to prevent lethal complications.
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42
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Kakino T, Yokoyama H, Eshima K. Significance of troponin I level as a marker of disease activity in the management of acute necrotizing eosinophilic myocarditis with normal peripheral eosinophil count: a case report. Eur Heart J Case Rep 2018; 2:yty139. [PMID: 31020215 PMCID: PMC6426096 DOI: 10.1093/ehjcr/yty139] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 10/28/2018] [Indexed: 11/15/2022]
Abstract
Background Eosinophilic myocarditis is characterized by myocardial eosinophilic infiltration and is largely associated with hypereosinophilia. However, eosinophilic myocarditis with a normal peripheral eosinophilic count has been previously reported. Since the absence of eosinophilia poses a challenge for therapeutic management, we evaluated whether troponin I (TnI) levels can be used in the management of eosinophilic myocarditis where peripheral eosinophilia is absent. Case summary We report the case of a 77-year-old woman who developed cardiogenic shock due to acute necrotizing eosinophilic myocarditis, which required mechanical circulatory support. She did not have hypereosinophilia, but endomyocardial biopsy confirmed massive infiltration of eosinophils into the myocardium. We administered high-dose corticosteroids for 3 days and she dramatically improved. Along with this, the TnI level, which was elevated at the time of patient presentation, also decreased after steroid therapy. Troponin I level did not increase again without taking any oral prednisolone, and the follow-up biopsy after 6 months showed complete recovery of eosinophilic myocarditis. Discussion Troponin I-guided treatment is a useful tool in the management of eosinophilic myocarditis because it helps with therapeutic decisions, especially in the absence of eosinophilia.
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Affiliation(s)
- Takamori Kakino
- Department of Cardiovascular Medicine, Saga-Ken Medical Centre Koseikan, 400, Nakahara, Kase-machi, Saga, Japan
| | - Hirotake Yokoyama
- Department of Cardiovascular Medicine, Saga-Ken Medical Centre Koseikan, 400, Nakahara, Kase-machi, Saga, Japan
| | - Kenichi Eshima
- Department of Cardiovascular Medicine, Saga-Ken Medical Centre Koseikan, 400, Nakahara, Kase-machi, Saga, Japan
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43
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Zenda T, Araki I, Nakamiya O, Ogawa M, Higashi K, Ueno T. Acute peri-myocarditis with an unusual initial manifestation of gallbladder edema and a profound eosinophilic surge during convalescence. Fukushima J Med Sci 2018; 64:95-102. [PMID: 30158336 DOI: 10.5387/fms.2018-08] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
A 29-year-old man with fever and right upper quadrant pain was referred to our hospital. Ultrasonography revealed intense gallbladder edema and pericardial effusion. Despite no symptoms and signs related to heart failure, the patient was clinically suspected of cardiac dysfunction related to acute peri-myocarditis based on his symptoms of preceding fever and headache, pericardial effusion, positive troponin T value, elevated B-type natriuretic peptide level, and sequential changes on electrocardiography. With a profound eosinophilic surge (8,022/µL) during convalescence, acute peri-myocarditis and gallbladder edema resolved spontaneously. This case instructively shows that acute peri-myocarditis initially manifests with abdominal symptoms, mimicking acute acalculous cholecystitis. In addition, an extensive review of acute myocarditis cases with peripheral eosinophilia suggests that there is a subgroup characterized by a predilection for young and middle-aged men, concurrence of pericardial effusion, transient eosinophilic surge during convalescence, and favorable outcome.
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Affiliation(s)
- Takahiro Zenda
- Department of Internal Medicine, Asanogawa General Hospital
| | - Ichiro Araki
- Department of Internal Medicine, Asanogawa General Hospital
| | | | - Mitsuko Ogawa
- Department of Clinical Laboratory, Asanogawa General Hospital
| | | | - Toshio Ueno
- Department of Internal Medicine, Kanazawa Medical Station VieC
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Khalid M, Gayam V, Dahal S, Ur Rahman E, Fadllala K, Kaler J, Khalid M, Dufresne A. Hypereosinophilic Syndrome Complicated by Eosinophilic Myocarditis With Dramatic Response to Steroid. J Investig Med High Impact Case Rep 2018; 6:2324709618764512. [PMID: 29581993 PMCID: PMC5862364 DOI: 10.1177/2324709618764512] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 02/02/2018] [Accepted: 02/08/2018] [Indexed: 11/17/2022] Open
Abstract
Introduction. Eosinophilic myocarditis is an infiltrative disease that affects the myocardium leading to various presentations. It can be precipitated by medications, helminthiasis, or hypereosinophilic syndrome. Case. We present the case of a young, male patient who presented with palpitations and dyspnea and was found to have heart failure with reduced ejection fracture of 12%. His past medical history was significant for recent lung problem treated with steroids. Based on his history and laboratory findings, he was started on intravenous steroids for treatment of eosinophilic myocarditis. Within 3 days, his ejection fracture improved to 35%. Conclusion. Given the nonspecific clinical presentations, mimicking other diseases, high index of suspicion is warranted to diagnose eosinophilic myocarditis. This is crucial as early detection and treatment with steroids can lead to a dramatic response.
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Affiliation(s)
| | - Vijay Gayam
- Interfaith Medical Center, Brooklyn, NY, USA
| | - Sumit Dahal
- Interfaith Medical Center, Brooklyn, NY, USA
| | | | | | | | - Mowyad Khalid
- Detroit Medical Center, Wayne State University, Detroit, MI, USA
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Novo Matos J, Pereira N, Glaus T, Wilkie L, Borgeat K, Loureiro J, Silva J, Law V, Kranjc A, Connolly DJ, Luis Fuentes V. Transient Myocardial Thickening in Cats Associated with Heart Failure. J Vet Intern Med 2017; 32:48-56. [PMID: 29243322 PMCID: PMC5787177 DOI: 10.1111/jvim.14897] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2017] [Revised: 10/25/2017] [Accepted: 11/07/2017] [Indexed: 12/17/2022] Open
Abstract
Background Cats with hypertrophic cardiomyopathy (HCM) and congestive heart failure (CHF) can have resolution of both left ventricular hypertrophy and CHF. Objectives To describe the clinical characteristics of cats with transient myocardial thickening (TMT) and CHF compared with a control population of cats without resolution of HCM. Animals A total of 21 cats with TMT, 21 cats with HCM. Methods Retrospective study. Clinical records at 4 veterinary centers were searched for TMT cases and a control group of cats with HCM and CHF. TMT was defined as initial maximal left ventricular wall thickness (LVWT) ≥6 mm with left‐sided CHF, with subsequent resolution of CHF, reduction in left atrium/aorta (LA/Ao), and LVWT<5.5 mm. HCM was defined as persistent LVWT ≥6 mm. Results Cats with TMT were younger (2 [0.4–11.4] years) than cats with HCM (8 [1.6–14] years) (P < 0.0001), and antecedent events were more common (15/21 versus 6/21, respectively) (P = 0.01). In cats with TMT, LVWT normalized from 6.8 [6.0–9.7] mm to 4.8 [2.8–5.3] mm and LA/Ao decreased from 1.8 [1.6–2.3] to 1.45 [1.2–1.7] after a mean interval of 3.3 (95% CI: 1.8–4.7) months. CHF recurred in 1 of 21 TMT and 15 of 21 cats with HCM. Cardiac treatment was discontinued in 20 of 21 cats with TMT and 0 of 21 HCM cats. All cats with TMT survived, whereas 8 of 19 cats with HCM died during the study period. Conclusions and Clinical Importance TMT occurs in younger cats, and antecedent events are common. The prognosis is better in cats with CHF associated with TMT than HCM.
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Affiliation(s)
- J Novo Matos
- Royal Veterinary College, University of London, Hatfield, UK.,Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - N Pereira
- Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - T Glaus
- Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - L Wilkie
- Royal Veterinary College, University of London, Hatfield, UK
| | - K Borgeat
- Highcroft Veterinary Referrals, Bristol, UK
| | - J Loureiro
- North Downs Specialists Referrals, Surrey, UK
| | - J Silva
- North Downs Specialists Referrals, Surrey, UK
| | - V Law
- Royal Veterinary College, University of London, Hatfield, UK
| | - A Kranjc
- Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - D J Connolly
- Royal Veterinary College, University of London, Hatfield, UK
| | - V Luis Fuentes
- Royal Veterinary College, University of London, Hatfield, UK
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46
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Bluett R, McDonnell D, O'Dowling C, Vaughan C. Eosinophilic myocarditis as a first presentation of eosinophilic granulomatosis with polyangiitis (Churg-Strauss syndrome). BMJ Case Rep 2017; 2017:bcr-2017-221227. [PMID: 29170172 PMCID: PMC5720267 DOI: 10.1136/bcr-2017-221227] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
We present the case of a 28-year-old man who presented with chest pain and elevated cardiac biomarkers, with no evidence of acute ischaemia. He had a pronounced eosinophilia, abnormal echocardiographic, cardiac MRI and CT findings. He underwent transbronchial biopsy of carinal lymph nodes and of lung parenchyma. Endomyocardial biopsy yielded an eosinophilic infiltrate. He was treated with high dose glucocorticoids and made a rapid recovery. Testing for FIP1L1-PDGFRA and other BCR-ABL1 mutations was negative. Ultimately, he was diagnosed with eosinophilic granulomatosis with polyangiitis, also known as Churg-Strauss syndrome.
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Affiliation(s)
- Ronan Bluett
- Department of Cardiology, Mercy University Hospital, Cork, Ireland
| | - David McDonnell
- Department of Cardiology, Mercy University Hospital, Cork, Ireland
| | - Claire O'Dowling
- Department of Cardiology, Mercy University Hospital, Cork, Ireland.,Department of Cardiology, Cork University Hospital, Cork, Ireland
| | - Carl Vaughan
- Department of Cardiology, Mercy University Hospital, Cork, Ireland.,Department of Cardiology, Cork University Hospital, Cork, Ireland
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48
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Song T, Jones DM, Homsi Y. Therapeutic effect of anti-IL-5 on eosinophilic myocarditis with large pericardial effusion. BMJ Case Rep 2017; 2017:bcr-2016-218992. [PMID: 28546236 DOI: 10.1136/bcr-2016-218992] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Eosinophilic myocarditis (EM) is a rare myocardial disease that results from various eosinophilic diseases, such as idiopathic hypereosinophilic syndrome, helminth infection, medications and vasculitis. Patients with EM may present with different severities, ranging from mild symptoms to a life-threatening condition. Diagnosis of EM is a challenge and requires an extensive workup, including endomyocardial biopsy. Treatment options are limited because EM is rare and there is a lack of randomised controlled trials. We report a case of EM that presented as cardiac tamponade, which was initially treated with high-dose prednisone and immunosuppressant medications without significant improvement. Mepolizumab (anti-interleukin (IL)-5 antibody) was then applied, leading to an increased ejection fraction and stabilised cardiac function. This case report shows, for the first time, that mepolizumab has novel effects in treating EM. Our findings suggest that mepolizumab can be used as a steroid-sparing agent for treating EM.
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Affiliation(s)
- Tengyao Song
- Center for Molecular and Cellular Physiology, Albany Medical College, Albany, New York, USA
| | | | - Yamen Homsi
- Rheumatology, State University of New York Downstate Medical Center, Brooklyn, New York, USA
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49
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Chen YW, Chang YC, Su CS, Chang WC, Lee WL, Lai CH. Dramatic and early response to low-dose steroid in the treatment of acute eosinophilic myocarditis: a case report. BMC Cardiovasc Disord 2017; 17:115. [PMID: 28482853 PMCID: PMC5422902 DOI: 10.1186/s12872-017-0547-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2016] [Accepted: 04/28/2017] [Indexed: 01/22/2023] Open
Abstract
Background Eosinophilic myocarditis encompasses a variety of etiologies and the prognosis varies. For patients with a hypersensitive response to medications, high-dose corticosteroids and discontinuation of culprit medications are the main treatments. Case presentation We reported a young man with biopsy-proven eosinophilic myocarditis which was possibly induced by Chinese herbal medicine. His heart failure and left ventricular hypertrophy improved soon after low-dose corticosteroid. Conclusion Low-dose corticosteroid may be effective in selected patients with eosinophilic myocarditis. Early echocardiographic follow-up is mandatory for evaluation of the clinical response. Electronic supplementary material The online version of this article (doi:10.1186/s12872-017-0547-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Yu-Wei Chen
- Division of Cardiology, Department of Internal Medicine, Taichung Veterans General Hospital Chiayi Branch, Chiayi, Taiwan, Republic of China
| | - Yu-Cheng Chang
- Department of Cardiology, Asia University Hospital, Taichung, Taiwan, Republic of China
| | - Chieh-Shou Su
- Division of Interventional Cardiology, Cardiovascular Center, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sect. 4, Taichung, 40705, Taiwan, Republic of China.,School of Medicine, National Yang-Ming University, Taipei, Taiwan, Republic of China
| | - Wei-Chun Chang
- Division of Interventional Cardiology, Cardiovascular Center, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sect. 4, Taichung, 40705, Taiwan, Republic of China
| | - Wen-Lieng Lee
- Division of Interventional Cardiology, Cardiovascular Center, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sect. 4, Taichung, 40705, Taiwan, Republic of China.,School of Medicine, National Yang-Ming University, Taipei, Taiwan, Republic of China
| | - Chih-Hung Lai
- Division of Interventional Cardiology, Cardiovascular Center, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sect. 4, Taichung, 40705, Taiwan, Republic of China. .,School of Medicine, National Yang-Ming University, Taipei, Taiwan, Republic of China.
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Luethy D, Slack J, Kraus MS, Gelzer AR, Habecker P, Johnson AL. Third-Degree Atrioventricular Block and Collapse Associated with Eosinophilic Myocarditis in a Horse. J Vet Intern Med 2017; 31:884-889. [PMID: 28295606 PMCID: PMC5435066 DOI: 10.1111/jvim.14682] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Revised: 01/10/2017] [Accepted: 01/31/2017] [Indexed: 12/01/2022] Open
Abstract
Third‐degree atrioventricular block (AVB) and primary inflammatory myocarditis are uncommon findings in horses. The horse of this report presented for collapse at rest and was found to have multiple cardiac arrhythmias, most notably 3rd‐degree AVB. The horse was subsequently diagnosed with eosinophilic myocarditis on necropsy, a rare form of myocarditis not previously reported in horses. Despite extensive testing, an etiologic agent could not be identified, illustrating the difficulty in identifying a specific cause of myocarditis in horses.
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Affiliation(s)
- D Luethy
- Department of Clinical Studies-New Bolton Center, School of Veterinary Medicine, University of Pennsylvania, Kennett Square, PA
| | - J Slack
- Department of Clinical Studies-New Bolton Center, School of Veterinary Medicine, University of Pennsylvania, Kennett Square, PA
| | - M S Kraus
- Ryan Veterinary Hospital, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA
| | - A R Gelzer
- Ryan Veterinary Hospital, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA
| | - P Habecker
- Department of Clinical Studies-New Bolton Center, School of Veterinary Medicine, University of Pennsylvania, Kennett Square, PA
| | - A L Johnson
- Department of Clinical Studies-New Bolton Center, School of Veterinary Medicine, University of Pennsylvania, Kennett Square, PA
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