Dobutamine Induced Hypersensitivity Eosinophilic Myocarditis.

Hypersensitivity eosinophilic myocarditis is a rare histological finding. It has been previously described as an incidental finding, most commonly in the ex-planted hearts of patients who were on inotropic support. A 71-year-old man with ischemic cardiomyopathy ACC/AHA stage D heart failure was briefly on home dobutamine infusion as a bridge to left ventricular assist device (LVAD) placement. Prior to his surgery, the patient presented with worsening cardiogenic shock and recurrent episodes of ventricular tachycardia shortly after initiation of dobutamine. The multidisciplinary team decided to proceed with an emergent LVAD placement despite his presentation. The immediate post-operative course was complicated by vasoplegia and profound shock which eventually led to his death. The LV apical core biopsy obtained at the time of LVAD implant later revealed eosinophilic infiltration without necrosis, which is suggestive of hypersensitivity eosinophilic myocarditis (Image 1) likely due to dobutamine infusion. This case highlights that hypersensitivity eosinophilic myocarditis should be kept in the differentials for patients on dobutamine infusion with unexplained, rapidly progressive cardiogenic shock. [ABSTRACT FROM AUTHOR]