Li Mengxuan, Chen Hong
Department of Hematology, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China.
West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, 37 Guoxue Lane, Wuhou District, Chengdu, Sichuan, 610041, China.
BMC Cardiovasc Disord. 2025 May 8;25(1):355. doi: 10.1186/s12872-025-04826-1.
Eosinophilic myocarditis (EM) is a rare cardiac condition that is often difficult to diagnose. Although endocardial myocardial biopsy is considered the gold standard for diagnosis, sampling errors can lead to false-negative results. This case report discusses the diagnosis and treatment of dilated cardiomyopathy in a patient with EM.
In this article, we report a case of a 32-year-old female patient diagnosed with dilated cardiomyopathy. EM was strongly suspected based on a progressive increase in eosinophil count, the absence of known allergens or common etiological factors, elevated eosinophil levels in alveolar lavage fluid, and a diagnosis of eosinophilic pneumonia. However, endocardial myocardial biopsy results failed to show definite evidence of myocarditis. Despite the implementation of various therapeutic interventions including pharmacological treatments, electrical defibrillation, endotracheal intubation, and ventilator-assisted breathing, the patient's condition showed minimal improvement. Subsequent initiation of extracorporeal membrane oxygenation and intra-aortic balloon pump support also failed to achieve the anticipated recovery. The patient subsequently underwent heart transplantation, and cardiac tissue samples were sent for pathology examination. The diagnostic report revealed a large number of eosinophils, confirming the diagnosis of EM. After heart transplantation, the patient's vital signs gradually stabilized, and she was discharged in good condition.
Endocardial myocardial biopsy plays an important role in diagnosing EM but may yield false-negative results. In this case, heart transplantation provided critical diagnostic information, with the pathology report confirming the presence of eosinophils and supporting the diagnosis of EM.
嗜酸性粒细胞性心肌炎（EM）是一种罕见的心脏疾病，常常难以诊断。尽管心内膜心肌活检被认为是诊断的金标准，但取样误差可能导致假阴性结果。本病例报告讨论了一名患有EM的扩张型心肌病患者的诊断和治疗。
在本文中，我们报告了一例32岁女性患者，被诊断为扩张型心肌病。基于嗜酸性粒细胞计数逐渐增加、无已知过敏原或常见病因、肺泡灌洗液中嗜酸性粒细胞水平升高以及嗜酸性粒细胞性肺炎的诊断，强烈怀疑为EM。然而，心内膜心肌活检结果未能显示心肌炎的确切证据。尽管实施了包括药物治疗、电除颤、气管插管和呼吸机辅助呼吸在内的各种治疗干预措施，但患者的病情改善甚微。随后启动体外膜肺氧合和主动脉内球囊泵支持也未能实现预期的恢复。患者随后接受了心脏移植，并将心脏组织样本送去进行病理检查。诊断报告显示大量嗜酸性粒细胞，证实了EM的诊断。心脏移植后，患者的生命体征逐渐稳定，并顺利出院。
心内膜心肌活检在诊断EM中起着重要作用，但可能产生假阴性结果。在本病例中，心脏移植提供了关键的诊断信息，病理报告证实了嗜酸性粒细胞的存在并支持EM的诊断。
