Tartaglia Francesco, Messina Maria Rita, Rizzo Stefania, Heffler Enrico, Panico Cristina
Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, 4, 20079 Pieve Emanuele-Milan, Italy.
Cardiovascular Department, IRCCS Humanitas Research Hospital, Via Alessandro Manzoni, 56, 20089 Rozzano-Milan, Italy.
Eur Heart J Case Rep. 2025 Mar 21;9(4):ytaf127. doi: 10.1093/ehjcr/ytaf127. eCollection 2025 Apr.
Eosinophilic myocarditis is a rare condition that can be associated with hypersensitivity reactions. Endomyocardial biopsy (EMB) is required for diagnosis, especially when cardiac magnetic resonance (CMR) is inconclusive. Immunosuppressive treatment is usually limited to corticosteroids.
Two days following an inclisiran injection for dyslipidaemia management, a 72-year-old Caucasian male with a history of coronary artery disease experienced progressive shortness of breath. Suspecting a hypersensitivity reaction to inclisiran, corticosteroids were administered. After discontinuing corticosteroids, the patient experienced recurrent dyspnoea. Laboratory tests indicated eosinophilia, increased serum immunoglobulin E (IgE), and positive specific serum IgE for . Imaging tests and a lung biopsy revealed pulmonary aspergillosis, while CMR showed myocardial inflammation. The patient was initially treated with itraconazole and steroid therapy. However, he was re-hospitalized for worsening of the cardiac and respiratory condition after tapering steroids. A diagnosis of severe eosinophilic asthma associated with allergic bronchopulmonary aspergillosis was established. Löffler's endocarditis related to -induced eosinophilia was suspected and confirmed by repeated CMR and an EMB. Mepolizumab, an interleukin-5 (IL-5) inhibitor, was initiated resulting in symptom resolution and absence of inflammation at the 6-month follow-up CMR.
This case describes an uncommon response to inclisiran that resulted in -induced, steroid-dependent, eosinophilic systemic inflammation, resulting in severe asthma and endocarditis. It demonstrates how biological IL-5 inhibitors are effective in treating both components, emphasizing the necessity of a multidisciplinary strategy.
嗜酸性粒细胞性心肌炎是一种罕见疾病，可与超敏反应相关。诊断需要进行心内膜心肌活检（EMB），尤其是在心脏磁共振成像（CMR）结果不明确时。免疫抑制治疗通常限于使用皮质类固醇。
一名72岁有冠状动脉疾病史的白人男性在注射inclisiran治疗血脂异常两天后，出现进行性气短。怀疑对inclisiran过敏，给予了皮质类固醇治疗。停用皮质类固醇后，患者再次出现呼吸困难。实验室检查显示嗜酸性粒细胞增多、血清免疫球蛋白E（IgE）升高以及针对……的特异性血清IgE呈阳性。影像学检查和肺活检显示为肺曲霉病，而CMR显示心肌炎症。患者最初接受伊曲康唑和类固醇治疗。然而，在逐渐减少类固醇剂量后，他因心脏和呼吸状况恶化再次住院。确诊为与过敏性支气管肺曲霉病相关的重度嗜酸性粒细胞性哮喘。怀疑与……诱导的嗜酸性粒细胞增多相关的吕弗勒心内膜炎，并通过重复CMR和EMB得到证实。开始使用白细胞介素-5（IL-5）抑制剂美泊利珠单抗，在6个月的随访CMR中症状缓解且无炎症。
本病例描述了对inclisiran的一种罕见反应，该反应导致……诱导的、类固醇依赖的嗜酸性粒细胞性全身炎症，引发严重哮喘和心内膜炎。它展示了生物IL-5抑制剂如何有效治疗这两种病症，强调了多学科策略的必要性。
