Beyond the Skin: Fulminant Myopericarditis in DRESS Syndrome Requiring Cardiac Transplantation
Document Type
Conference Proceeding
Publication Date
4-1-2025
Publication Title
Journal of the American College of Cardiology
Abstract
Background: DRESS (drug reaction with eosinophilia and systemic symptoms) is a severe form of drug reaction which is most commonly associated with exposure to certain anti epileptics and certain antibiotics. It frequently manifests as fever and skin rash. Myocarditis is a rare and fatal complication of DRESS syndrome. Case: A 34-year-old female presented with epigastric pain, skin rash and fever. She recently had history of trichomoniasis and was given fluconazole, trimethoprim-sulfamethoxazole along with metronidazole. She also had raised transaminase levels at the time of admission along with raised eosinophilic count. Given the concerns for DRESS syndrome, she was started on IV methylprednisone. During her hospital stay, she was found to be hypotensive with EKG showing diffuse ST elevations along with elevated high sensitivity troponins (>5000 ng/L). Echocardiogram revealed moderately increased concentric wall thickness with a small echogenic pericardial effusion. Cardiac MRI showed markedly increased native T1 and T2 relaxation times, diffuse mid myocardial late gadolinium enhancement with depressed left ventricular function (34%) and pericardial effusion. All these features were consistent with severe form of diffuse myocarditis. Decision-making: She was started on low dose norepinephrine infusion and transferred to a transplant center. An endomyocardial biopsy was performed, and the patient was placed on Left Atrial-Veno-Arterial Extracorporeal Oxygenation support as the patient was in cardiogenic shock. Biopsy revealed myocardium with extensive lymphocytic infiltrates admixed with eosinophils and necrotic myocardial cells. She subsequently underwent orthotopic cardiac transplantation. Besides high dose methylprednisolone, she was also initiated on cyclophosphamide and tacrolimus. Biopsy of the explanted heart showed global severe eosinophilic myocarditis. Conclusion: This case highlights the rare but life threatening complication of DRESS syndrome associated myocarditis. Despite early initiation of systemic steroids, our patientʼs condition progressed to cardiogenic shock necessitating advanced mechanical circulatory support.
Volume
85
Issue
12 Suppl
First Page
4535
Last Page
4535
Recommended Citation
Chhabra K, Mahmood S, Sankar PR, Trivax JE, Walsh DG, Timmis SBH. Beyond the skin: fulminant myopericarditis in DRESS syndrome requiring cardiac transplantation. J Am Coll Cardiol. 2025 Apr 1;85(12 Suppl):4535. doi:10.1016/S0735-1097(25)05019-3
DOI
10.1016/S0735-1097(25)05019-3
Comments
American College of Cardiology Meeting, March 29-31, 2025, Chicago, IL