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Rise and fall of the eosinophils in heart failure: a rare but important phenomenon seen with cardiomyopathy
  1. Danish Ali1,2,
  2. David Snead3,
  3. Vijay Anand Dhakshinamurthy4,
  4. Prithwish Banerjee4,5,6
  1. 1Cardiology, University Hospital Coventry, Coventry, UK
  2. 2Health Sciences, University of Warwick, Coventry, West Midlands, UK
  3. 3Pathology, University Hospitals Coventry and Warwickshire, Coventry, UK
  4. 4Cardiology, University Hospitals Coventry and Warwickshire, Coventry, UK
  5. 5CIRAL, Coventry University, Coventry, UK
  6. 6Warwick Medical School, Coventry, West Midlands, UK
  1. Correspondence to Prof Prithwish Banerjee, prithwish.banerjee{at}


A 65-year-old lady and a 69-year-old gentleman, both with a background history of adult-onset asthma, presented with clinical features of heart failure (HF). High-sensitivity cardiac troponin T and eosinophils were significantly raised, along with poor left ventricular (LV) systolic function on cardiac imaging. Endocardial and skin biopsy (in cases 1 and 2, respectively) showed eosinophilic infiltration. This in combination with the clinical features confirmed the diagnosis of eosinophilic myocarditis (EM) secondary to eosinophilic granulomatosis with polyangiitis in case 1. Both cases were managed with high-dose intravenous corticosteroids and conventional HF medication. Case 1 successfully responded clinically with improvement in LV systolic function. Case 2 required further immunosuppressive therapy (rituximab) and cardiac resynchronisation therapy, but eventually died of septic shock secondary to immunosuppressives. Our cases highlight the importance of early diagnosis and treatment of EM and ongoing monitoring of patients on immunosuppressive therapy.

  • heart failure
  • immunology
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  • Contributors DA conducted the literature review and provided significant contribution towards drafting the manuscript. DS provided analysis of the histology obtained and provided contribution towards the manuscript. VAD provided analysis and interpretation of the cardiac MRI images obtained and edited the manuscript. PB was responsible for the overall clinical care of the cases and provided significant contribution towards editing the case report.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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