Eosinophilic myocarditis as presentation of hypereosinophilic syndrome.

Abstract

A 67-year-old female with history of eosinophilic gastritis, was admitted with a first episode of heart failure (HF). The X-ray showed a bilateral interstitial infiltrate with a large left pleural effusion (Panel A), with abundant eosinophils in the pleural drainage and eosinophilia in blood stream (22 × 109, normal value 0,5–1 × 109). The transthoracic echocardiogram observed a normal left ventricular function (53%) (see Supplementary Video S1) with restrictive mitral filling pattern (Panel B) and a severely diminished global longitudinal strain of—9.6% (Panel C). The cardiac resonance (see Supplementary Video S2) revealed a septal intramyocardial and anterolateral subepicardial late gadolinium enhancement (Panels D and E) with normal right ventricle function, non-thickened pericardium, and no effusions. Due to high suspicious of a restrictive myocardiopathy (RMC) secondary to a hyperosinophilic syndrome, a right heart catheterization (RHC) and a cardiac biopsy were scheduled. The RHC was compatible with RMC (Panel F), with pulmonary hypertension (mean pulmonary pressure of 28 mmHg), ‘dip & plateau pattern’, and pressure equalization between chambers. Finally, the endomyocardial biopsy (Panel G) revealed an important infiltration of eosinophils in myocardial tissue, confirming the diagnosis of eosinophilic myocarditis (EM), in the context of hypereosinophilic syndrome. High doses of intravenous corticoids plus HF treatment were started, and the patient evolved favourably.