Eosinophilic myopericarditis associated with eosinophilic granulomatosis with polyangiitis
C. Urgent initiation of high-dose steroids, colchicine, and high-dose NSAIDs during hospitalization
The keys to the diagnosis in this case are the elevated biomarkers suggesting cardiac damage, decreased left ventricular ejection fraction, and late gadolinium enhancement on cardiac magnetic resonance imaging, all of which are consistent with myocardial injury. The patient’s peripheral eosinophilia without clonal expansion and history of adult-onset asthma are most suggestive of eosinophilic myopericarditis (EM) associated with eosinophilic granulomatosis with polyangiitis (EGPA), formerly known as Churg-Strauss syndrome.
Eosinophilic myopericarditis is a rare form of myocarditis characterized by eosinophilic infiltration of the myocardium.1 It can present with chest pain, acute heart failure, arrhythmias, and mural thrombus, and it is associated with high mortality, especially when presenting as fulminant myocarditis.2 This case highlights the broad differential diagnosis of EM causative mechanisms, which include primary neoplastic processes, helminthic and parasitic infections, allergic immune response and hypersensitivity, autoimmune diseases, and idiopathic hypereosinophilia.2- 5 A recent meta-analysis found the most common causative mechanism of EM to be idiopathic or undefined (36%), followed by hypersensitivity (34%) and EGPA-associated (13%) causative mechanisms.2 Eosinophilic myopericarditis associated with EGPA is often accompanied by asthma and peripheral eosinophilia, as was the case with this patient.2