RT Journal Article
SR Electronic
T1 Rise and fall of the eosinophils in heart failure: a rare but important phenomenon seen with cardiomyopathy
JF BMJ Case Reports
FD BMJ Publishing Group Ltd
SP bcr-2017-221081
DO 10.1136/bcr-2017-221081
VO 2018
A1 Danish Ali
A1 David Snead
A1 Vijay Anand Dhakshinamurthy
A1 Prithwish Banerjee
YR 2018
UL http://casereports.bmj.com/content/2018/bcr-2017-221081.abstract
AB 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.