Eosinophilic myocarditis is a rare type of myocarditis usually caused by a hypersensitive or allergic reaction. Its prevalence in myocardial autopsy examinations was approximately 0,5 % [25]. It is more frequent in patients who are undergoing heart transplant where it was detected in 7 to 20 % of candidates [25]. In this case, it may be a complication connected with the medication, primarily with dobutamine [16].
The basic characteristic of the disease in a finding of eosinophilia in blood. Its severity is assessed by the absolute number of eosinophils per mm³. Aetiology of eosinophilic myocarditis includes various agents – antibiotics (penicillin, sulfonamides, cephalosporine etc.), antipsychotics (clozapine), non-steroidal anti-inflammatory drugs (indomethacin), diuretics, some ACE-inhibitors (captopril and enalapril), digoxin, dobutamine, small-pox vaccine and others. Non-pharmacological causes of the eosinophilic heart impairment are parasitic infections, some systematic disorders (primarily Churg Strauss syndrome) and hematological diseases, various malignant diseases and idiopathic hypereosinophilic syndromes [44, 45].
Clinical manifestation and laboratory and imaging methods results are varied and may even detect no pathologies. In most of the patients, peripheral eosinophilia is present, however, its presence is not necessary for the diagnosis. The definitive diagnosis is confirmed by EMB findings [46]. A curiosity of LGE during CMRI examination in eosinophilic myocarditis is its localization in the subendocardial layer. In contrast to ischemic heart disease, the myocardial damage is not limited just in the areas supplied by coronary arteries [47].
Some authors set aside, in addition, acute eosinophilic necrotizing myocarditis accompanied by a distinct eosinophilia, necrosis and oedema of the myocardium and manifesting as fulminant myocarditis [25].
The most important therapeutic measure in patients with eosinophilic myocarditis is the removal of the agent if it is known. In most of the patients with non-infectious type of this myocarditis, immunosuppressive therapy consisting primarily from corticosteroids is indicated [46].
Author of the opening picture: Blausen Medical
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References:
16) KUBÁNEK M., Kapitola 8.2.: Myokarditidy. In: KAUTZNER J., MELENOVSKÝ V., et al. Srdeční selhání – aktuality pro klinickou praxi. Praha: Mladá fronta a.s., 2015. pp. 147–157. ISBN: 978-80-204-3573-6.
25) ABDULLAH, M.A.A., L.P. STRAATMAN a et al. Eosinophilic myocarditis: Case series and review of literature. Canadian Journal of Cardiology. 2006, 22(14), 1233–1237.
44) BAANDRUP. Eosinophilic myocarditis. Herz. 2012, 2012(37), 849-853.
45) E., ECKART a et al. Incidence and Follow-Up of Inflammatory Cardiac Complications After Smallpox Vaccination. Journal of the American College of Cardiology. 2004, 44(1), 201-205.
46) KUCHYNKA a et al. Current Diagnostic and Therapeutic Aspects of Eosinophilic Myocarditis. BioMed Research International [online]. 2016, 2016(-), 6 stran [cit. 2017-02-05].
47) E., PETERSEN a et al. Subendocardial and papillary muscle involvement in a patient with Churg-Strauss syndrome, detected by contrast enhanced cardiovascular magnetic resonance. Heart [online]. 2005, 91(1), e9 [cit. 2017-02-07].
