Background: Eosinophilic myocarditis is a life-threatening condition with a heterogeneous clinical presentation and aetiology. Cases of drug-induced or parasitic myocarditis have been reported but there is scant literature on the involvement of treatments, such as doxycycline, and eosinophil degranulation due to parasitic lysis.
Case Summary: Here, we report the case of a 59-year-old man without a relevant past medical history who developed a skin rash with hepatic cytolysis and mild eosinophilia. No aetiology was found despite an exhaustive work-up, but a parasitic infestation was suspected in view of the patient's daily contact with freshwater environments. A few days after doxycycline administration, the patient's clinical state worsened rapidly leading to a ventricular electrical storm-related cardiogenic shock requiring mechanical support. After initiation of high-dose corticosteroid therapy, cardiac function normalized promptly allowing for withdrawal of the mechanical support. An endomyocardial biopsy led to the diagnosis of eosinophilic myocarditis, which was congruent with the cardiac magnetic resonance imaging data.
Discussion: The main aetiologies reported for eosinophilic myocarditis are often allergic reactions, such as DRESS syndrome in developed countries, or infections, especially due to parasites in other countries. Drugs such as tuberculosis medications, antipsychotics, and antiepileptics have been implicated, as well as antibiotics, e.g. minocycline, but there has been no case of doxycycline-related eosinophilic myocarditis reported to date. Parasitic lysis is known to induce the activation of eosinophils and their on-site degranulation but no case has been reported on myocarditis due to parasitic lysis after administration of antiparasitic drugs.
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http://dx.doi.org/10.1093/ehjcr/ytae587 | DOI Listing |
BMJ Case Rep
December 2024
Department of Cardiac Thoracic and Vascular Anesthesia, JSS Medical college and Hospital, Mysore, Karnataka, India.
Adverse drug reactions (ADRs) are common in clinical practice, especially among patients with multiple comorbidities and polypharmacy. The ADRs associated with medications may be minor or life-threatening. Many available ADR assessment scales and pharmacovigilance programmes have streamlined the early diagnosis and management of ADRs.
View Article and Find Full Text PDFEur Heart J Case Rep
December 2024
Department of Cardiology, Tsuyama Chuo Hospital, 1756 Kawasaki, Tsuyama, Okayama 708-0841, Japan.
Background: Brugada phenocopy (BrP) is a condition that induces reversible Brugada-like electrocardiographic (ECG) changes in patients without true Brugada syndrome. We present two cases of fulminant eosinophilic myocarditis that showed Type 1 Brugada ECG changes in the early phase of the clinical course.
Case Summary: Case 1 was a 76-year-old man who developed fulminant eosinophilic myocarditis with ventricular tachycardia while hospitalized for heart failure.
Schizophr Bull
December 2024
Department of Psychiatry, Graduate School of Medicine, Tohoku University, Sendai, Miyagi, 980-8574, Japan.
Background And Hypothesis: Eosinophilia has not been highlighted in clozapine-induced adverse inflammatory events, as it is often asymptomatic and self-limiting, while drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome occurs rarely. This study aimed to reveal the temporal relationships between eosinophilia and other inflammatory events during clozapine initiation.
Study Design: The temporal relationships between eosinophilia and other inflammatory events were evaluated among 241 patients with schizophrenia treated with clozapine for the first time at 7 hospitals.
Eur Heart J Case Rep
October 2024
Baker Heart and Diabetes Institute, Melbourne, Victoria 3004, Australia.
Background: Fulminant eosinophilic myocarditis (EM) is a rare and often fatal condition that may present atypically and be complicated by ventricular arrhythmias. Treatment involves high-dose corticosteroids to suppress eosinophilia, as well as increasing use of mepolizumab, an anti-interleukin-5 antibody with evidence for long-term efficacy and safety.
Case Summary: A 38-year-old woman presented to the emergency department with neck pain and fatigue, and after extensive investigation was diagnosed with EM secondary to idiopathic hypereosinophilic syndrome.
Arq Bras Cardiol
October 2024
Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil.
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