Eosinophilia associated with dobutamine allergy causes eosinophilic endomyocarditis confirmed by serial endomyocardial biopsies

Abstract

We report a case of eosinophilic endomyocarditis caused by eosinophilia due to dobutamine allergy and successfully treated by a short-term and medium-dose steroid administration. Serial endomyocardial biopsies were useful for early diagnosis and evaluation of the effect of the treatment. Eosinophilic endomyocarditis due to dobutamine allergy is a rare entity; however, because of the high utilization rate of dobutamine in patients with low output heart failure, it is important to recognize that additional deterioration of cardiac function caused by eosinophilic endomyocarditis makes prognosis poor and early intervention is necessary. <Learning objective: Eosinophilic endomyocarditis due to dobutamine allergy is a rare entity; however, because of the high utilization rate of dobutamine in patients with low output heart failure, it is important to recognize that additional deterioration of cardiac function caused by eosinophilic endomyocarditis makes their prognosis poor and early intervention is necessary. Serial endomyocardial biopsies were useful for early diagnosis and evaluation of the effect of the treatment.>

Alarming Eosinophilia From Dobutamine Infusion

“…Dobutamine infusions commonly contain sodium bisulfite, which is a known allergen [ 4 ]. The eosinophilia usually correlates with infusion duration, with short-term treatment associated with local and immediate hypersensitivity reactions, and long-term treatment causing severe peripheral eosinophilia [ 5 ]. Additionally, dobutamine contains many other compounds that may lead to hypersensitivity reactions [ 6 ].…”

“…The diagnosis is made by linking the onset of eosinophilia with the timing of dobutamine infusion and ruling out other causes, confirmed by an endomyocardial biopsy when myocarditis is suspected [ 8 ]. Treatment is through dobutamine cessation, followed by steroid therapy in refractory cases [ 5 ].…”

Incidence and Predictors of Eosinophilic Myocardial Hypersensitivity in Patients Receiving Home Dobutamine

“…However, there have been case reports linking the use of inotropes, in particular dobutamine, to eosinophilic myocardial hypersensitivity (EMH) reactions. [5][6][7][8] In observational studies of patients who have undergone transplantation, eosinophilic or hypersensitivity myocarditis has been reported in 7%-23% of explanted hearts. [9][10][11] Despite several case reports of dobutamine hypersensitivity, there remains a lack of data on incidence and predictors of EMH in patients receiving home inotrope therapy.…”

“…However, there have been case reports linking the use of inotropes, in particular dobutamine, to eosinophilic myocardial hypersensitivity (EMH) reactions. 5–8 In observational studies of patients who have undergone transplantation, eosinophilic or hypersensitivity myocarditis has been reported in 7%–23% of explanted hearts. 9–11…”