Eosinophilic myocarditis without hypereosinophilia accompanied by giant cell infiltration

Sugiyama, Eitaro; Takenaka, Takashi; Kato, Mizuki; Minoshima, Akiho; Muto, Harutatsu; Fujita, Masaaki; Sato, Minoru; Inoue, Hitoki; Nakamura, Hiroshi; Hasebe, Naoyuki

doi:10.1016/j.jccase.2015.07.004

Cited by 3 publications

(3 citation statements)

References 9 publications

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“…The distribution of eosinophils in human tissues is normally organ dependent and varies considerably. The distribution may be explained by tissue-specific chemokines or reflect the existence of eosinophil subpopulations in vivo ( 26 , 29 , 188 , 189 ). The impact of cell subpopulations in primary or idiopathic eosinophilia has not been studied but may contribute to explaining the manifestations in different organs ( 65 ).…”

Section: Discussionmentioning

confidence: 99%

The multidisciplinary approach to eosinophilia

et al. 2023

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Eosinophilic granulocytes are normally present in low numbers in the bloodstream. Patients with an increased number of eosinophilic granulocytes in the differential count (eosinophilia) are common and can pose a clinical challenge because conditions with eosinophilia occur in all medical specialties. The diagnostic approach must be guided by a thorough medical history, supported by specific tests to guide individualized treatment. Neoplastic (primary) eosinophilia is identified by one of several unique acquired genetic causes. In contrast, reactive (secondary) eosinophilia is associated with a cytokine stimulus in a specific disease, while idiopathic eosinophilia is a diagnosis by exclusion. Rational treatment is disease-directed in secondary cases and has paved the way for targeted treatment against the driver in primary eosinophilia, whereas idiopathic cases are treated as needed by principles in eosinophilia originating from clonal drivers. The vast majority of patients are diagnosed with secondary eosinophilia and are managed by the relevant specialty—e.g., rheumatology, allergy, dermatology, gastroenterology, pulmonary medicine, hematology, or infectious disease. The overlap in symptoms and the risk of irreversible organ involvement in eosinophilia, irrespective of the cause, warrants that patients without a diagnostic clarification or who do not respond to adequate treatment should be referred to a multidisciplinary function anchored in a hematology department for evaluation. This review presents the pathophysiology, manifestations, differential diagnosis, diagnostic workup, and management of (adult) patients with eosinophilia. The purpose is to place eosinophilia in a clinical context, and therefore justify and inspire the establishment of a multidisciplinary team of experts from diagnostic and clinical specialties at the regional level to support the second opinion. The target patient population requires highly specialized laboratory analysis and therapy and occasionally has severe eosinophil-induced organ dysfunction. An added value of a centralized, clinical function is to serve as a platform for education and research to further improve the management of patients with eosinophilia. Primary and idiopathic eosinophilia are key topics in the review, which also address current research and discusses outstanding issues in the field.

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Section: Discussionmentioning

confidence: 99%

The multidisciplinary approach to eosinophilia

et al. 2023

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“…Consistent monitoring of the eosinophil count in peripheral blood is important in cases of heart failure of an unknown etiology. Some cases of eosinophilic myocarditis without peripheral eosinophilia were diagnosed by endomyocardial biopsy [ 5 , 7 ], and prednisolone therapy was effective in most cases of eosinophilic myocarditis [ 14 ]. Although a cardiac biopsy was not performed in our case, we excluded parasitic disease, autoimmune disease, and drug-induced cardiomyopathy.…”

Section: Discussionmentioning

confidence: 99%

“…Cardiac dysfunction is a common complication of HES and is a major cause of morbidity and mortality [3,4]. However, diagnosing HES can be challenging, especially in the absence of peripheral eosinophilia [5][6][7].…”

Section: Introductionmentioning

confidence: 99%

Cardiomegaly and Low Voltage Suggest Cardiac Involvement in a Patient With Hypereosinophilic Syndrome: A Case Report

Kashima¹,

Ooi²,

Yoshishige³

et al. 2023

Cureus

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Hypereosinophilic syndrome is a heterogeneous group of disorders, the majority of which are idiopathic. Cardiac manifestations, particularly eosinophilic myocarditis and endomyocardial fibrosis, are a typical course of morbidity and mortality in hypereosinophilic syndrome. We present a case of a patient with asthma and idiopathic eosinophilia who presented with dyspnea and edema. Cardiac ultrasonography showed pericardial effusion and reduced left ventricular motion, which persisted despite heart failure therapy, although pulmonary congestion improved. The peripheral blood eosinophil count was markedly elevated four days after admission, even though eosinophilia was not present at admission. Parasitic disease, autoimmune disease, and drug-induced cardiomyopathy were excluded as possibilities. A high dose of steroid therapy was started due to eosinophilic myocarditis. Cardiac function improved soon after therapy, along with a reduction in eosinophils. Upon retrospective examination, cardiomegaly and low voltage were observed, along with an elevation in the eosinophil count 15 months before admission. Monitoring chest radiography and electrocardiograms according to fluctuations in eosinophils may enable early detection and treatment of cardiac involvement in patients with hypereosinophilic syndrome, as demonstrated by this case.

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