Management of a patient with eosinophilic myocarditis and normal peripheral eosinophil count: case report and literature review.

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Eosinophilic myocarditis (EM) is a rare disease characterized by myocardial eosinophilic infiltration. This infiltration of the myocardium has been described as a hypersensitivity response induced by a variety of causes ranging from drugs (including inotropes, vasodilatators, antibiotics, diuretics, etc), parasitic infections, and neoplasia. EM is also frequently encountered in autoimmune disorders, such as Churg–Strauss syndrome and Loffler disease.1 In the vast majority of cases, EM is associated with hypereosinophilia2 (ie, eosinophils >1.5/nL). Patients with EM may present with mild, moderate, or even severe heart failure symptoms sometimes accompanied with arrhythmias. EM in the absence of hypereosinophilia not only poses a great diagnostic challenge but also creates difficulty with post-treatment follow-up unless invasive procedures are used. Another difficulty in the management of this disorder is the lack of standardized therapeutic medical management. In the case below, we describe an otherwise healthy woman with no prior history of cardiac disease or allergy admitted to our hospital with recurrent arrhythmia, elevated troponin T values, and newly diagnosed reduced left ventricular ejection fraction. A 59-year-old woman with history of systemic hypertension well controlled with bisoprolol presented to our hospital …