Home Cardiology Letters 2021 Cardiology Letters Vol.30, No.1, p.57–61, 2021

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Cardiology Letters Vol.30, No.1, p.57–61, 2021

Title: Eozinofil – „dobrý sluha, zlý pán“ / Eosinophil – “a good servant but a bad master”
Author: V. Šimovičová, M. Danková, M. Luknár, P. Lesný, V. Lauko, P. Talarčík, E. Gonçalvesová

Abstract:

Eosinophilic myocarditis (EM) is a rare form of myocarditis with a very heterogeneous etiology. It is characterized by the presence of eosinophilic infiltrate in the myocardium. The course can vary from an asymptomatic clinical picture to life-threatening conditions.
We describe a case of a 29-year-old patient with a history of bronchial asthma hospitalized for chestpain and manifesting heart failure. A moderate decrease of ejection fraction of the undilated left ventricle chamber was found. High levels of troponin, NTproBNP and eosinophilia were present in the laboratory findings. By endomyocardial biopsy we confirmed the presence of an eosinophilic infiltrate with a histological pattern of myocarditis. We did not confirm clonal proliferation of eosinophils. Corticoid therapy was initiated. After a week we observed normalization of eosinophils and a decrease in cardiac specific enzymes. Different types of ventricular tachycardias, which required multiple external defibrilation, occured during treatment. An ICD was implanted in the secondary prevention of sudden cardiac death. Ventricular arrhythmias have been stabilized by a combination of pharmacotherapy and individualized programming of ICD functions. Control biopsy was without histological finding of myocarditis. Left ventricular ejection fraction improved by 10%: the patient has been asymptomatic.
Eosinophilic myocarditis is a rare disease but with poor prognosis in the acute phase. With the presence of eosinophilia in peripheral blood, this potential cause of acute heart failure should also be considered. Clear diagnosis must be confirmed by endomyocardial biopsy. The basis of treatment is corticoid therapy, which positively affects survival. Fig. 4, Tab. 1, Ref. 13,

Abstrakt. Eozinofilná myokarditída (EM) je zriedkavá forma myokarditídy s veľmi heterogénnou etiológiou. Vyznačuje sa prítomnosťou eozinofilného infiltrátu v myokarde. Priebeh môže byť variabilný od asymptomatického klinického obrazu až po život ohrozujúce stavy.
Opisujeme prípad 29-ročného pacienta s anamnézou bronchiálnej astmy, hospitalizovaného pre bolesti na hrudníku a manifestované srdcové zlyhávanie. Zistila sa stredne závažná systolická dysfunkcia nedilatovanej ľavej komory. V laboratórnom náleze boli prítomné vysoké hodnoty troponínu, NTproBNP a eozinofília. Endomyokardiálnou biopsiou sme potvrdili prítomnosť eozinofilného infiltrátu s histologickým obrazom myokarditídy. Klonálnu proliferáciu eozinofilov sme nepotvrdili. Iniciovali sme kortikoterapiu, po ktorej sme pozorovali normalizáciu počtu eozinofilov a pokles kardiošpecifických enzýmov. V priebehu liečby sa objavili rôzne typy komorových tachykardií s viacnásobnou potrebou externej defibrilácie. V sekundárnej prevencii náhlej kardiálnej smrti sme implantovali ICD. Komorové poruchy rytmu sa podarilo stabilizovať kombináciou farmakoterapie a individualizovaného programovania funkcií ICD. Kontrolná biopsia bola bez histologického nálezu myokarditídy.

 



Keywords: eosinophilic myocarditis – heart failure – rare diseases
Published online: 01-Apr-2021
Year: 2021, Volume: 30, Issue: 1 Page From: 57, Page To: 61
doi:10.4149/Cardiol_2021_1_10


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