Rao Karan, Arustamyan Michael, Walling Abby, Christodoulidis Georgios, Ashwath Mahi, Hagedorn Joshua, Priya Sarv
Department of Radiology, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA 522422, USA.
Department of Cardiovascular Medicine, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA 52242, USA.
Eur Heart J Case Rep. 2023 Feb 18;7(3):ytad090. doi: 10.1093/ehjcr/ytad090. eCollection 2023 Mar.
Eosinophilic myocarditis (EM) secondary to eosinophilic granulomatosis with polyangiitis (EGPA) is a rare disease, for which cardiac magnetic resonance imaging (CMRI) is a useful non-invasive modality for diagnosis. We present a case of EM in a patient who recently recovered from COVID-19 and discuss the role of CMRI and endomyocardial biopsy (EMB) to differentiate between COVID-19-associated myocarditis and EM.
A 20-year-old Hispanic male with a history of sinusitis and asthma, and who recently recovered from COVID-19, presented to the emergency room with pleuritic chest pain, dyspnoea on exertion, and cough. His presentation labs were pertinent for leucocytosis, eosinophilia, elevated troponin, and elevated erythrocyte sedimentation rate and C-reactive protein. The electrocardiogram showed sinus tachycardia. Echocardiogram showed an ejection fraction of 40%. The patient was admitted, and on day 2 of admission, he underwent CMRI which showed findings of EM and mural thrombi. On hospital day 3, the patient underwent right heart catheterization and EMB which confirmed EM. The patient was treated with steroids and mepolizumab. He was discharged on hospital day 7 and continued outpatient heart failure treatment.
This is a unique case of EM and heart failure with reduced ejection fraction as a presentation of EGPA, in a patient who recently recovered from COVID-19. In this case, CMRI and EMB were critical to identify the cause of myocarditis and helped in the optimal management of this patient.
嗜酸性粒细胞性肉芽肿伴多血管炎（EGPA）继发的嗜酸性粒细胞性心肌炎（EM）是一种罕见疾病，心脏磁共振成像（CMRI）是诊断该病的一种有用的非侵入性检查方法。我们报告一例近期从新冠病毒疾病（COVID-19）康复的患者发生EM的病例，并讨论CMRI和心内膜心肌活检（EMB）在鉴别COVID-19相关性心肌炎和EM中的作用。
一名20岁的西班牙裔男性，有鼻窦炎和哮喘病史，近期从COVID-19康复，因胸膜炎性胸痛、劳力性呼吸困难和咳嗽就诊于急诊室。其检查结果显示白细胞增多、嗜酸性粒细胞增多、肌钙蛋白升高、红细胞沉降率和C反应蛋白升高。心电图显示窦性心动过速。超声心动图显示射血分数为40%。患者入院，入院第2天接受CMRI检查，结果显示为EM并伴有壁血栓。住院第3天，患者接受了右心导管检查和EMB，确诊为EM。患者接受了类固醇和美泊利单抗治疗。他于住院第7天出院，并继续接受门诊心力衰竭治疗。
这是一例独特的EM病例，表现为射血分数降低的心力衰竭，是EGPA的一种表现，发生在一名近期从COVID-19康复的患者身上。在该病例中，CMRI和EMB对于确定心肌炎病因至关重要，并有助于对该患者进行最佳管理。
