Blumetti Ludovica, De Perna Maria Luisa, Reinehr Michael, Pedrazzini Giovanni
Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Via Tesserete 48, CH-6900 Lugano, Switzerland.
Institut für Pathologie und Molekularpathologie, Universitätsspital Zürich, Rämistrasse 100 8091 Zürich, Switzerland.
Eur Heart J Case Rep. 2021 Oct 7;5(10):ytab399. doi: 10.1093/ehjcr/ytab399. eCollection 2021 Oct.
Eosinophilic myocarditis (EM) is a rare and potentially life-threatening form of myocarditis, frequently (but not always) associated with eosinophilia, and presents with acute chest pain, or signs and symptoms of acute or chronic heart failure. Eosinophilic myocarditis has various aetiologies, including eosinophilic granulomatosis with polyangiitis (EGPA).
A 52-year-old female with a long-standing history of asthma, acral paraesthesia, subcutaneous nodules, and recurrent chest pain treated with anti-inflammatory drugs was admitted to our hospital with chest pain, repolarization disturbances, eosinophilia, and increased troponin levels. After an initial evaluation by coronary angiography, echocardiography and cardiac magnetic resonance, a definitive diagnosis of EM was made with the help of an endomyocardial biopsy. The aetiological diagnosis of EM as a manifestation of tissue involvement in EGPA was concluded after ruling out other possible causes of eosinophilia and with the help of other diagnostic criteria for EGPA (asthma, eosinophilia, and neuropathy). Therefore, we started with a high dosage of glucocorticoids, and attained relief of symptoms and normalization of eosinophilic count after a few days.
In cases of myocarditis (particularly if associated with eosinophilia), EM is a manifestation of EGPA and should be considered for a prompt differential diagnosis. Endomyocardial biopsy represents the gold standard for the diagnosis of EM. The mainstay of therapy for EM is immunosuppressive drugs to help prevent its evolution to a fulminant form and chronic progression towards restrictive cardiomyopathy.
嗜酸性粒细胞性心肌炎（EM）是一种罕见且可能危及生命的心肌炎形式，常（但不总是）与嗜酸性粒细胞增多相关，表现为急性胸痛或急慢性心力衰竭的体征和症状。嗜酸性粒细胞性心肌炎有多种病因，包括嗜酸性粒细胞肉芽肿性多血管炎（EGPA）。
一名52岁女性，有长期哮喘、肢端感觉异常、皮下结节病史，曾用抗炎药物治疗复发性胸痛，因胸痛、复极异常、嗜酸性粒细胞增多和肌钙蛋白水平升高入住我院。经冠状动脉造影、超声心动图和心脏磁共振初步评估后，在心肌内膜活检的帮助下确诊为EM。在排除嗜酸性粒细胞增多的其他可能原因并借助EGPA的其他诊断标准（哮喘、嗜酸性粒细胞增多和神经病变）后，得出EM作为EGPA组织受累表现的病因诊断。因此，我们开始使用高剂量糖皮质激素，几天后症状缓解，嗜酸性粒细胞计数恢复正常。
在心肌炎病例中（特别是与嗜酸性粒细胞增多相关时），EM是EGPA的一种表现，应考虑进行快速鉴别诊断。心肌内膜活检是诊断EM的金标准。EM的主要治疗方法是免疫抑制药物，以帮助预防其发展为暴发性形式和向限制性心肌病的慢性进展。
