Murphy Katie, Waldo Oral, Lohrmann Graham M, Tazelaar Henry D, Jokerst Clinton E, Mookadam Farouk
Tex Heart Inst J. 2017 Jun 1;44(3):219-222. doi: 10.14503/THIJ-16-5859. eCollection 2017 Jun.
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.
反应性嗜酸性粒细胞增多与炎症性肠病有关，但其与嗜酸性粒细胞性心肌炎的关联较为罕见。我们报告一例42岁男性患者，该患者因腹泻继发低血容量性休克，近期诊断为非缺血性心肌病（左心室射血分数为0.29）。实验室检查显示外周血嗜酸性粒细胞显著增多。心脏磁共振成像显示亚急性至慢性心肌炎的证据，心内膜活检结果与嗜酸性粒细胞性心肌炎一致。结肠活检标本显示溃疡性结肠炎，未见嗜酸性粒细胞。血液学评估排除了嗜酸性粒细胞增多的其他原因。患者接受了皮质类固醇治疗；腹泻得到缓解，但射血分数短期内无改善，因此植入了植入式心律转复除颤器。一年后的随访显示，患者的左心室射血分数已提高至0.42。
