Abstract
Background: Acute eosinophilic myocarditis (EM) is a rare form of heart failure that is characterized by myocardial eosinophilic infiltration usually in association with peripheral eosinophilia. The underlying cause is variable and can include allergic reactions, parasitic infection, idiopathic hypereosinophilic syndrome, malignancy, Loeffler’s syndrome, Churg-Strauss syndrome (CSS), early giant cell myocarditis and malignancy. The course is potentially fatal, and early diagnosis and treatment with steroids is essential.
Conclusion: Here, we present an illustrative case of eosinophilic myocarditis secondary to CSS followed by a brief review of epidemiology, pathogenesis, diagnosis and treatment of both disease entities.
Keywords: Eosinophilic myocarditis, cardiomyopathy, churg-strauss, heart failure, steroids, epidemiology.
Graphical Abstract
[1]
Watts RA, Lane SE, Bentham G, Scott DG. Epidemiology of systemic vasculitis: A ten-year study in the United Kingdom. Arthritis Rheum 2000; 43: 414-9.
[2]
Masi AT, Hunder GG, Lie JT, et al. The American College of Rheumatology 1990 criteria for the classification of Churg-Strauss syndrome (allergic granulomatosis and angiitis). Arthritis Rheum 1990; 33: 1094-100.
[3]
Pelà G, Tirabassi G, Pattoneri P, Pavone L, Garini G, Bruschi G. Cardiac involvement in the Churg-Strauss syndrome. Am J Cardiol 2006; 97: 1519-24.
[4]
Neumann T, Manger B, Schmid M, et al. Cardiac involvement in Churg-Strauss syndrome: impact of endomyocarditis. Medicine (Baltimore) 2009; 88: 236-43.
[6]
Pagnoux C, Guilpain P, Guillevin L. Churg-Strauss syndrome. Curr Opin Rheumatol 2007; 19: 25-32.
[7]
Guillevin L, Lhote F, Gayraud M, et al. Prognostic factors in polyarteritis nodosa and Churg-Strauss syndrome. A prospective study in 342 patients. Medicine (Baltimore) 1996; 75: 17-28.
[8]
Bosch X, Guilabert A, Espinosa G, Mirapeix E. Treatment of antineutrophil cytoplasmic antibody associated vasculitis: A systematic review. JAMA 2007; 298: 655-69.
[10]
Amini R, Nielsen C. Eosinophilic myocarditis mimicking acute coronary syndrome secondary to idiopathic hypereosinophilic syndrome: A case report. J Med Case Reports 2010; 4: 40.
[11]
Burke AP, Saenger J, Mullick F, Virmani R. Hypersensitivity myocarditis. Arch Pathol Lab Med 1991; 115: 764-9.
[12]
Takkenberg JJ, Czer LS, Fishbein MC, et al. Eosinophilic myocarditis in patients awaiting heart transplantation. Crit Care Med 2004; 32: 714-21.
[13]
De Alava E, Panizo-Santos A, Fernandez-Gonzalez AL, Pardo-Mindan FJ. Eosinophilic myocarditis in patients waiting for heart transplantation. Cardiovasc Pathol 1995; 4: 43-6.
[14]
Ommen SR, Seward JB, Tajik AJ. Clinical and echocardiographic features of hypereosinophilic syndromes. Am J Cardiol 2000; 86: 110-3.
[15]
Cools J, DeAngelo DJ, Gotlib J, et al. A tyrosine kinase created by fusion of the PDGFRA and FIP1L1 genes as a therapeutic target of imatinib in idiopathic hypereosinophilic syndrome. N Engl J Med 2003; 348: 1201-14.
[16]
Park HY, Lee SU, Huh S, Kong Y, Magnaval JF. A seroepidemiological survey for toxocariasis in apparently healthy residents in Gangwon-do, Korea. Korean J Parasitol 2002; 40: 113-7.
[17]
Kang SY, Kang MK, Kim MY, et al. A case of severe hypereosinophilia caused by toxocara infection after ingestion of raw ostrich liver. Korean J Asthma Allergy Clin Immunol 2011; 31: 144-7.
[18]
Fenoglio JJ Jr, McAllister HA. Jr. Mullick FG. Drug related myocarditis. I. Hypersensitivity myocarditis. Hum Pathol 1981; 12: 900-7.
[19]
Tai PC, Hays DJ, Clark JB, Spry CJ. Toxic effects of human eosinophil products on isolated rat heart cells in vitro. Biochem J 1982; 204: 75-80.
[20]
Young JD, Peterson CG, Venge P, Cohn ZA. Mechanism of membrane damage mediated by human eosinophil cationic protein. Nature 1986; 321: 613-6.
[21]
Talierco CP, Olney BA, Lie JT. Myocarditis related to drug hypersensitivity. Mayo Clin Proc 1985; 60: 463-8.
[22]
Li HS, Ligons DL, Rose NR. Genetic complexityof autoimmune myocarditis. Autoimmun Rev 2008; 7(3): 168-73.
[23]
Bezzina CR, Pazoki R, Bardai A, et al. Genome-wide association study identifies a susceptibility locus at 21q21 for ventricular fibrillation in acute myocardial infarction. Nat Genet 2010; 42(8): 688-91.
[24]
Frustaci A, Priori SG, Pieroni M, et al. Cardiac histological substrate in patients with clinical phenotype of Brugada syndrome. Circulation 2005; 112(24): 3680-7.
[25]
Patane S, Marte F. Revelation of Brugada electrocardiographic pattern during a febrile state associated with acute myocardial infarction. Int J Cardiol 2010; 144(1): e1-4.
[26]
Japanese Circulation Society Task Force Committee on Acute and
Chronic Myocarditis. Guidelines for diagnosis and treatment of
myocarditis (JCS 2009) [Internet] Tokyo: Japanese Circulation
Society; [cited 2015 Mar 10]. Available from: http://www.j-circ.or.jp/guideline/pdf/JCS2009_izumi_h.pdf
[27]
Arima M, Kanoh T, Kawano Y, Oigawa T, Yamagami S, Matsuda S. Serum levels of eosinophil cationic protein in patients with eosinophilic myocarditis. Int J Cardiol 2002; 84: 97-9.
[29]
Deb K, Djavidani B, Buchner S, et al. Time course of eosinophilic myocarditis visualized by CMR. J Cardiovasc Magn Reson 2008; 10: 21.
[30]
Mahrholdt H, Goedecke C, Wagner A, et al. Cardiovascular magnetic resonance assessment of human myocarditis: A comparison to histology and molecular pathology. Circulation 2004; 109: 1250-8.
[31]
Burke AP, Saenger J, Mullick F, Virmani R. Hypersensitivity myocarditis. Arch Pathol Lab Med 1991; 115: 764-9.
[32]
Aggarwal A, Bergin P, Jessup P, Kaye D. Hypersensitivity myocarditis presenting as cardiogenic shock. J Heart Lung Transplant 2001; 20: 1241-4.
[33]
Galiuto L, Enriquez-Sarano M, Reeder GS, et al. Eosinophilic myocarditis manifesting as myocardial infarction: Early diagnosis and successful treatment. Mayo Clin Proc 1997; 72: 603-10.
[34]
Al Ali AM, Straatman LP, Allard MF, Ignaszewski AP. Eosinophilic myocarditis: Case series and review of literature. Can J Cardiol 2006; 22: 1233-7.
[35]
Morimoto S, Kubo N, Hiramitsu S, et al. Changes in the peripheral eosinophil count in patients with acute eosinophilic myocarditis. Heart Vessels 2003; 18: 193-6.
[36]
Lin YC, Oliveira GH, Villa-Forte A. Churg-Strauss syndrome and persistent heart failure: active disease or damage? J Clin Rheumatol 2013; 19: 390-2.
[37]
Brambatti M, Matassini MV, Adler ED, Klingel K, Camici PG, Ammirati E. Eosinophilic myocarditis: Characteristics, treatment, and outcomes. J Am Coll Cardiol 2017; 70(19): 2363-75.
[38]
Assa’ad AH, Spicer RL, Nelson DP, Zimmermann N, Rothenberg ME. Hypereosinophilic syndromes. Chem Immunol 2000; 76: 208-29.
[39]
Khabbaz Z, Grinda JM, Fabiani JN. Extracorporeal life support: An effective and noninvasive way to treat acute necrotizing eosinophilic myocarditis. J Thorac Cardiovasc Surg 2007; 133(4): 1122-3.
[40]
Chau EM, Chow WH, Chiu C, Wang E. Treatment and outcome in biopsy proven fulminant myocarditis in adults. Int J Cardiol 2006; 110(3): 405-6.
[41]
Thomson D, Chamsi-Pasha H, Hasleton P. Heart transplantation for Churg–Strauss syndrome. Br Heart J 1989; 62: 409-10.
[42]
Rosenberg M, Lorenz HM, Gassler N, et al. Rapid progressive eosinophilic cardiomyopathy in a patient with Churg–Strauss syndrome (CSS). Clin Res Cardiol 2006; 95: 289-94.
[43]
Ferrari M, Pfeifer R, Poerner TC, et al. Bridge to recovery in a patient with Churg–Strauss myocarditis by long-term percutaneous support with microaxial blood pump. Heart 2007; 93: 1419.
[44]
Cui N, Su L, Wang H, et al. A case report of churg–strauss syndrome presenting with cardiogenic shock treated with extracorporeal membrane oxygenation. Medicine 2015; 94(43): e1757.
Related Books
Blood Oxidant Ties: The Evolving Concepts in Myocardial Injury and Cardiovascular Disease
Advancements in Cardiovascular Research and Therapeutics: Molecular and Nutraceutical Perspectives
Herbal Medicine: Back to the Future
Cardiac Care and COVID-19: Perspectives in Medical Practice
Nanomedicinal Approaches Towards Cardiovascular Disease
Herbal Medicine: Back to the Future
Article Metrics
81
4