Eosinophilia and Ulcerative Colitis Associated with Eosinophilic Myocarditis

Abstract

Reactive eosinophilia is associated with inflammatory bowel disease, but its association with eosinophilic myocarditis is rare. We report a case of a 42-year-old man who presented with hypovolemic shock secondary to diarrhea and recently diagnosed nonischemic cardiomyopathy (left ventricular ejection fraction, 0.29). Laboratory evaluation revealed marked peripheral eosinophilia. Cardiac magnetic resonance imaging showed evidence of subacute-to-chronic myocarditis, and endomyocardial biopsy results were consistent with eosinophilic myocarditis. Colonic biopsy specimens revealed ulcerative colitis and no eosinophils. Hematologic evaluation was negative for an alternative cause of eosinophilia. The patient was given corticosteroids; his diarrhea resolved, but there was no short-term improvement in his ejection fraction, so an implantable cardioverter-defibrillator was placed. Follow-up at one year showed that the patient's left ventricular ejection fraction had improved to 0.42.

Cardiogenic shock treated with immunosuppression: a case presentation of acute fulminant eosinophilic myocarditis

“…EM associated with Ulcerative Colitis (UC) has previously been described in the literature and is associated with more fulminant forms of myocarditis [4]. Myocarditis related to In iximab use has also been described, due to a hypersensitivity reaction, but this as the cause of myocarditis in this patient is unlikely given the absence of peripheral eosinophilia [5].…”

Successful Treatment with Corticosteroids in an 11-Year-Old Patient with Crohn’s Disease and Myopericarditis—Case Report

“…In the literature, which mainly concerns adults, a higher incidence of myocarditis is noted in patients with ulcerative colitis (UC) than CD [ 11 ]. The pathomechanism of myocarditis in IBD seems to be more complex and not fully understood [ 12 ]. The coexistence of infectious, autoimmune conditions or drug-related complications are considered to be involved in development of miocarditis.…”

Successful Treatment of Acute Fulminant Eosinophilic Myocarditis in a Patient with Ulcerative Colitis Using Steroid Therapy and Percutaneous Cardiopulmonary Support

“…UC is a severe disease with many extra-colonic manifestations, such as skin involvement, rheumatic problems, and ocular complications. The frequency of myocarditis associated with UC has been studied only rarely, but there appears to be a high risk of mortality in these patients (5, 6). The mechanisms of myocarditis associated with UC have not been fully elucidated.…”

“…Controversy surrounds whether steroid therapy is always necessary for the treatment of EM (1). In contrast, some reports have shown that the treatment of myocarditis with and without eosinophilia associated with UC is focused and effective for the management of UC, often using steroid therapy and/or immunosuppression therapy along with heart failure therapy (6, 18). Previous reports have also demonstrated that steroid therapy is a frequently used and effective treatment for EM patients with UC (6).…”

“…The disease is often fatal, and a particularly high in-hospital mortality rate has been reported when EM presents in the fulminant form (also known as acute necrotizing EM) (3, 4). Myocarditis associated with ulcerative colitis (UC) is also a rare disorder with a serious risk of mortality (5, 6). An endomyocardial biopsy facilitates the definite diagnosis of EM (7, 8), and steroid therapy has been used for the treatment of EM (9).…”