1. A challenging case of eosinophilic myocarditis leading to heart failure and transplantation.
- Author
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Harmouch W, Zhang JR, Peterson JM, Uran DP, Buja LM, Zhao B, Boor PJ, Murrieta JI, Chatila K, and Stevenson HL
- Subjects
- Humans, Male, Adult, Biopsy, Immunosuppressive Agents therapeutic use, Treatment Outcome, Shock, Cardiogenic etiology, Shock, Cardiogenic pathology, Shock, Cardiogenic therapy, Shock, Cardiogenic diagnosis, Heart Transplantation, Myocarditis pathology, Heart Failure etiology, Eosinophilia pathology, Eosinophilia complications, Heart-Assist Devices, Myocardium pathology
- 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., Competing Interests: Declaration of competing interest Declaration of competing interest: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)
- Published
- 2024
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