Eosinophilic myocarditis complicated by acute myocardial infarction--a case report

'Clinically suspected myocarditis with pseudoinfarct presentation' complicated with left ventricular aneurysm

A 51-year-old man presented with chest pain, high troponin level, inflammatory syndrome and ST-segment elevation in the anterior leads. While the transthoracic echocardiogram (TTE) showed anteroseptal hypokinesis and apical akinesis, the coronary angiogram was normal. Cardiac MR demonstrated a typical aspect of myocarditis (multiple areas of mid-myocardial late gadolinium enhancement, sparing the subendocardial layer, along with oedema). The initial diagnosis was clinically suspected myocarditis with pseudoinfarct presentation. However, the short-term evolution was not typical of this syndrome, since an apical transmural scar with aneurysm developed within 2 weeks. Seven years later, the patient remained asymptomatic, while Q waves persisted in anterior leads along with an apical aneurysm on TTE. A transmural myocardial necrosis with aneurysm is an unusual complication of acute myocarditis. The potential mechanisms accounting for the development of these lesions are reviewed, and the clinical implications for the diagnosis and monitoring of acute myocarditis are discussed.

A case report of eosinophilic myocarditis and a review of the relevant literature

BACKGROUND

Eosinophilic myocarditis (EM) is a relatively rare condition that may result from parasitic infections and allergic disease. Antituberculosis drugs may lead to focal myocardial infiltration by eosinophils (eosinophilic myocarditis). Symptoms may be severe, and, lead to rapidly-fatal outcomes. Early diagnosis and high-dose corticosteroids are the cornerstone of treatment, and, may lead to restoration of cardiac function with full recovery.

CASE PRESENTATION

We report a case of eosinophilic myocarditis secondary to eosinophilia caused by antituberculosis drugs with markedly elevated ECP, focal eosinophilic infiltration in CMR imaging and endomyocardial biopsy. Finally, high-dose corticosteroids were used to reverse the cardiac injury and to improve the clinical outcome.

CONCLUSION

Antituberculosis drugs can cause eosinophilic infiltration of, and damage to, the myocardium leading to rapid progression of the clinical symptoms. Myocardial biopsy is helpful in diagnosing the disease in the early stages and high-dose corticosteroids effectively improves the prognosis of this disease.

[Heart and freezer: about one case of hypereosinophilia and coronary spasm]

We report the case of a 41-year-old woman, non-smoker, without cardiovascular risk, hospitalised for acute ST elevation myocardial infarction. The coronarography showed no significant coronary stenosis and a methylergometrine test performed was positive. After the discovery of a moderate chronic hypereosinophilia, a review of the literature about eosinophile and coronary pathology was realised in order to make a link between hypereosinophilia and coronary spasm.

Eosinophilic myocarditis presenting with pediatric myocardial infarction

Determination of the etiology of myocardial infarction (MI) in children can present a challenge to the practitioner since cases of pediatric MI are rare and the causes can be diverse. We report an unusual case of pediatric eosinophilic myocarditis that presented with MI.

Acute eosinophilic myocarditis in a young woman

The first stage of eosinophilic myocarditis is called the necrotizing phase. This stage of eosinophilic myocarditis of unknown cause is often fulminant and rapidly fatal, occurring predominantly in males. Here, we report a case of eosinophilic myocarditis in the acute necrotizing phase occurred without known cause in a 23-year-old Japanese female. Severe diffuse hypokinesis of the left ventricular wall motion (ejection fraction 19.3%), significant concentric edematous thickening of the left ventricular wall (20.1 mm in diastole) and a moderate amount of pericardial effusion (10 mm wide echo free space posteriorly) were revealed by echocardiography. Eosinophils were observed and degranulated eosinophilic cationic proteins were stained with antibody against eosinophilic cationic proteins (EG2) in the myocardial specimens obtained by myocardial biopsy. In spite of its severity, the disease resolved promptly with steroid therapy.