Aota Hiroto, Yamamoto Hiroyuki, Isogai Jun, Imanaka-Yoshida Kyoko, Hiroe Michiaki, Tanaka Takahiro
Department of Cardiology, Cardiovascular Center, Showa General Hospital, Tokyo, Japan.
Department of Cardiovascular Medicine, Narita-Tomisato Tokushukai Hospital, Chiba, Japan.
Front Cardiovasc Med. 2021 Jun 23;8:678973. doi: 10.3389/fcvm.2021.678973. eCollection 2021.
Eosinophilic myocarditis is a rare subtype of myocarditis characterized by myocardial eosinophilic infiltration, and it is potentially fatal if left untreated. Although endomyocardial biopsy (EMB) is a cornerstone for the histological diagnosis of acute eosinophilic myocarditis (AEM), as it is an invasive procedure and has a low diagnostic accuracy, the diagnosis of AEM with hemodynamic instability remains challenging. We describe a case of AEM presenting as low-flow heart failure with preserved ejection fraction (HFpEF), with rapid progression to cardiogenic shock. The constellation of peripheral eosinophilia, increased left ventricular wall thickness, and HFpEF raised the suspicion of AEM. Contrast-enhanced computed tomography (CT) scan revealed heterogeneous hypoenhancement localized in the basal-to-mid septal and mid anterolateral walls of the left ventricle, strongly suggestive of acute inflammation. Based upon these findings, we performed CT-guided EMB, which lead to a definitive diagnosis. Subsequent high-dose corticosteroids allowed a rapid and dramatic recovery and normalization of cardiac structure and function. This case highlights the clinical importance of assessing AEM as a rare cause of HFpEF and the usefulness of CT-guided EMB in patients with hemodynamic instability.
嗜酸性粒细胞性心肌炎是心肌炎的一种罕见亚型，其特征为心肌嗜酸性粒细胞浸润，若不治疗可能会致命。尽管心内膜心肌活检（EMB）是急性嗜酸性粒细胞性心肌炎（AEM）组织学诊断的基石，但由于它是一种侵入性操作且诊断准确性较低，对于伴有血流动力学不稳定的AEM的诊断仍然具有挑战性。我们描述了一例表现为射血分数保留的低流量心力衰竭（HFpEF）的AEM病例，该病例迅速进展为心源性休克。外周血嗜酸性粒细胞增多、左心室壁厚度增加以及HFpEF的组合引发了对AEM的怀疑。对比增强计算机断层扫描（CT）显示左心室基底至中间隔及中间前侧壁存在不均匀的低密度强化，强烈提示急性炎症。基于这些发现，我们进行了CT引导下的EMB，从而得出了明确诊断。随后的大剂量皮质类固醇治疗使心脏结构和功能迅速显著恢复并正常化。该病例突出了将AEM评估为HFpEF罕见病因的临床重要性以及CT引导下EMB在血流动力学不稳定患者中的实用性。
