Cardiology Letters 2021, 30(1):57-61

Eosinophil - "a good servant but a bad master"

Šimovičová V¹, Danková M¹, Luknár M¹, Lesný P¹, Lauko V², Talarčík P³, Gonçalvesová E¹

¹ Kardiologická klinika LFUK a NÚSCH, a. s. Bratislava, Oddelenie zlyhávania a transplantácie srdca

² Pracoviska hematológie a transfúziológie NÚSCH, a. s. Bratislava

³ CYTOPATHOS, spol. s r. o., Bratislava, Slovenská republika

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.

Keywords: eosinophilic myocarditis; heart failure; rare diseases

Published: January 1, 2021  Show citation