Exploring the Skin-Heart Link: Reveling Eosinophilic Myocarditis in an Enigmatic Case

Document Type

Conference Proceeding

Publication Date

4-2-2024

Publication Title

Journal of the American College of Cardiology

Abstract

Background: Eosinophilic myocarditis is a rare and potentially lethal disease characterized by eosinophil infiltration of the myocardium. Case: 79-year-old female with history of primary biliary cirrhosis and persistent rash presented with chest pain for 2 days. She had leukocytosis with eosinophilia (4.8) with elevated troponin (1.63). EKG did not show ST-T wave changes. Echo showed severely increased left ventricular wall thickness with no wall motion abnormality. Subsequent cardiac catheterization showed non-obstructive coronary artery disease. MRI heart showed myo-pericarditis with increased T2 mapping of the entire myocardium, however it did not demonstrate classic features of eosinophilic syndrome including fibrotic apices or thrombus formation. Hypereosinophilia workup was positive for Strongyloides IgG antibody. Decision-making: Due to strong suspicion of eosinophilic myocarditis in background of indeterminate MRI results, patient underwent cardiac biopsy which showed myocytes infiltrated by abundant eosinophils with few lymphocytes consistent with eosinophilic myocarditis. She was started on pulse dose steroids after which eosinophils counts and symptoms improved. For the positive Strongyloides antibody, the patient was treated with ivermectin. Conclusion: For patients who present with cardiac symptoms and hypersensitivity features like rash and eosinophilia, eosinophilic myocarditis should be high on differential diagnosis.

Volume

83

Issue

13 Suppl

First Page

3602

Comments

American College of Cardiology 73rd Annual Scientific Session & Expo, April 6-8, 2024, Atlanta, GA

DOI

10.1016/S0735-1097(24)05592-X

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