Cardiac mobile thrombi formation in an unvaccinated young man with SARS-CoV-2 associated fulminant eosinophilic myocarditis.
Ontology highlight
ABSTRACT:
SUBMITTER: Yalcinkaya D
PROVIDER: S-EPMC8874805 | biostudies-literature | 2022 Feb
REPOSITORIES: biostudies-literature
Publications
Cardiac mobile thrombi formation in an unvaccinated young man with SARS-CoV-2 associated fulminant eosinophilic myocarditis.
Yalcinkaya Damla D Yarlioglues Mikail M Yigit Hasan H Caydere Muzaffer M Murat Sani Namik SN
European heart journal. Case reports 20220207 2
Similar Datasets
Project description:Eosinophilic myocarditis is a rare form of myocarditis characterized by eosinophilic infiltration and usually associated with peripheral hypereosinophilia. The clinical spectrum of eosinophilic myocarditis ranges widely, from mildly symptomatic to fulminant disease. When patients have fulminant eosinophilic myocarditis, high-dose corticosteroids can lead to dramatic improvement and peripheral eosinophil counts are used as an indicator of response to treatment. However, in some patients, peripheral eosinophilia is absent at initial presentation; reaching a diagnosis and determining treatment response can be challenging in this situation. This report describes a patient with fulminant eosinophilic myocarditis who initially presented with a normal peripheral eosinophil count, was diagnosed through an early endomyocardial biopsy, and was successfully treated with corticosteroids. Endomyocardial biopsy should be performed to confirm the presence of myocardial eosinophilic infiltration, especially for patients who present with fulminant myocarditis, even when peripheral eosinophilia is absent.
| S-EPMC10178658 | biostudies-literature
Project description:A 40-year-old woman with history of atopy and peripheral eosinophilia presented with clinical signs of heart failure. Echocardiography revealed a restrictive cardiomyopathy with biventricular thrombi. Hypereosinophilic syndrome resulting in eosinophilic myocarditis (Loeffler's syndrome) was diagnosed. This case highlights the workup, diagnosis, and management of hypereosinophilic syndrome with eosinophilic myocarditis. (Level of Difficulty: Advanced.).
| S-EPMC8299133 | biostudies-literature
Project description:Necrotizing eosinophilic myocarditis is a rare but potentially fatal condition that requires prompt recognition and treatment. We describe a case of a young athlete presenting with chest pain and breathlessness, with evidence of rapidly deteriorating cardiac function. The condition was successfully treated with corticosteroids, with no evidence of residual myocardial damage. This is the first reported case to demonstrate the utility of cardiac magnetic resonance imaging for diagnosis and monitoring response to treatment. It also highlights the value of endomyocardial biopsy in establishing a tissue diagnosis in cases of fulminant myocarditis, in order to direct treatment appropriately.
| S-EPMC5695162 | biostudies-other
Project description:BackgroundBrugada 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 summaryCase 1 was a 76-year-old man who developed fulminant eosinophilic myocarditis with ventricular tachycardia while hospitalized for heart failure. Case 2 was a 60-year-old man who presented with cardiogenic shock and was diagnosed with fulminant eosinophilic myocarditis. Both patients showed a Type 1 Brugada ECG at onset, and their ventricular function was greatly reduced. Regarding mechanical circulatory support, Case 1 was treated with venous-arterial extracorporeal membrane oxygenation and intra-aortic balloon pumping. Case 2 had venous-arterial extracorporeal membrane oxygenation and Impella CP insertion. Steroid therapy was introduced in both cases. In Case 1, the Type 1 Brugada ECG took 7 days to improve. Left ventricular function improved with time but right heart function was poor and right heart enlargement remained. In Case 2, the Type 1 Brugada ECG improved on the second day, and left and right heart function improved over time.DiscussionWe report two cases of fulminant eosinophilic myocarditis with Brugada-like ECG and severe right heart dysfunction. BrP in acute myocarditis may be an indicator of right heart failure and an important ECG marker in determining the indication for mechanical circulatory support and improvement of right heart function.
| S-EPMC11647588 | biostudies-literature
Project description: Not available
| S-EPMC6528500 | biostudies-literature
Project description:BackgroundEosinophilic myocarditis is a rare form of myocardial inflammatory disease. Eosinophilic infiltration of the myocardium is often the consequence of a systemic disorder but can remain unexplained in up to a third of patients. The disease course can range from mild to fulminant myocarditis and mortality remains high for fulminant cases.Case summaryA 42-year-old male was admitted for cardiogenic shock. He presented in another hospital with fever, low blood pressure, diffuse electrocardiogram-abnormalities, and elevated troponin T (4.5 µg/L; reference <0.013 µg/L) levels. Coronary angiography was unremarkable. Mechanical circulatory support with the ImpellaTM CP device was initiated. Since fulminant myocarditis was suspected and magnetic resonance imaging was not feasible in urgency, an endomyocardial biopsy was performed. He transiently developed right ventricular failure after ImpellaTM implantation, requiring the re-institution of an inotropic agent. Biopsy showed eosinophilic myocarditis, even though there was no increase in the peripheral blood eosinophil count. Methylprednisone and Ramipril were initiated to which he responded well. No systemic disease or parasitic infection was found during further work-up. Left ventricular ejection fraction rapidly improved and was completely normalized at discharge.DiscussionThis case demonstrates the usefulness of myocardial biopsy in fulminant myocarditis since the only histopathology guided us towards the diagnosis of eosinophilic myocarditis. Treatment with methylprednisone and an angiotensin-converting enzyme-inhibitor resulted in rapid improvement. Awake mechanical circulatory support with the ImpellaTM device proved feasible and might have helped by unloading the left ventricle, as was reflected in an immediate decrease in troponin levels, even before methylprednisone initiation.
| S-EPMC7891289 | biostudies-literature
Project description:BackgroundEosinophilic granulomatosis with polyangiitis (EGPA) is a systemic vasculitis that affects small-to-medium vessels of various organs and can lead to eosinophilic myocarditis, a rare but life-threatening condition. The diagnosis of EGPA is challenging due to overlapping features with other forms of vasculitis. Additionally, various clinical presentations of EGPA make its management complicated.Case summaryA 55-year-old man with a history of asthma presented with worsening chest pain. Peripheral hyper-eosinophilia, elevated troponin level, refractory pulseless ventricular tachycardia, and severe cardiac dysfunction suggested fulminant eosinophilic myocarditis. A multidisciplinary team comprising rheumatology, respirology, haematology, pathology, and cardiology specialists discussed the underlying cause of eosinophilia and diagnosed EGPA with the pathological findings of endomyocardial biopsy (EMB). Immunosuppressive therapy and optimal medical therapy for acute heart failure resulted in remission of myocarditis, as confirmed by follow-up echocardiography, cardiac magnetic resonance imaging, and EMB. Despite a good clinical course, mononeuritis rapidly worsened just before his discharge, requiring additional therapy. During the 2-year outpatient follow-up, the cardiac function remains well, and mononeuritis also improved.DiscussionThe multidisciplinary approach facilitated prompt and accurate diagnosis and treatment, despite the disease's diverse presentation, ultimately saving the patient's life. This case highlights the importance of systemic evaluations in patients with EGPA, potentially affecting multiple organs, for monitoring disease status and guiding its treatment. This case report also emphasizes that close follow-up and careful monitoring with cardiac multimodality imaging are important to ensure optimal management of heart failure caused by EGPA myocarditis.
| S-EPMC11804243 | biostudies-literature
Project description:We present the case of a 18-year-old female with fulminant lymphocytic myocarditis caused by Parvovirus B19 (PVB19), successfully treated using temporary LVAD. In the literature there is no consensus on the surgical strategy. While some surgeons prefer to use a single device supporting only the LV, others prefer to start immediately with a biventricular supporting. At pre-procedural ultrasound evaluation, her anatomical features were not suitable for a percutaneous device such as the Impella. Thus, a temporary paracorporeal continuous flow LVAD was inserted. The heart recovery allowed LVAD removal 9 days after the implant.
| S-EPMC8571226 | biostudies-literature
Project description:BackgroundFulminant 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 summaryA 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. The patient was treated with methylprednisolone for eosinophil suppression and warfarin due to the presence of biventricular apical thrombi. Despite previously stable haemodynamics, the patient had a cardiac arrest due to ventricular fibrillation on Day 11 of hospitalization, requiring 30 min of cardiopulmonary resuscitation and commencement of veno-arterial extracorporeal membrane oxygenation support due to refractory ventricular arrhythmias. The patient was urgently listed for heart transplant but a suitable match was not identified, and she was weaned to pharmacologic support on Day 34. The patient survived with minimal sequelae and has returned to full-time work. She remains on mepolizumab as a steroid-sparing agent, therapeutic anti-coagulation, and heart failure therapy.DiscussionThis report describes an atypical presentation of fulminant EM requiring weeks of mechanical circulatory support due to refractory arrhythmia rather than heart failure. The case also highlighted the benefits of non-invasive cardiac magnetic resonance imaging in both diagnosis and prognostication of EM, as well as the need to maintain a high index of suspicion for this rare disease.
| S-EPMC11635362 | biostudies-literature
Project description:BackgroundAcute myocarditis is a common condition, with viral infections being the most common aetiology in North America and Europe. Influenza A myocarditis is however rare. As clinical manifestation may be fulminant, early recognition and management are paramount and may impact overall prognosis by hindering complications such as thromboembolism. A brief review of the literature, diagnostic modalities, work-up and treatment are discussed.Case summaryWe present the case of a 42-year-old, previously healthy woman with recent flu-like symptoms, developing decompensated heart failure (HF) and cardiogenic shock within a week, due to Influenza A myocarditis. Biventricular thrombi were identified. Pharmacological haemodynamic support, followed by HF therapy, allowed full recuperation of heart function. Intracavitary thrombi disappeared under unfractionated heparin with bridging to rivaroxaban.DiscussionFulminant myocarditis due to Influenza A is rare and, to the best of our knowledge, has not been associated with intracardiac thrombi formation. Echocardiography is the essential first-line imaging modality. Cardiac magnetic resonance plays a major role in the diagnosis of myocarditis and may preclude the need for an endomyocardial biopsy in selected cases. Coronary angiography may be required to rule out ischaemic aetiology. First-line therapy in fulminant disease is pharmacological and, if required, mechanical haemodynamic support. Standard HF therapy complete the therapeutic options and should be introduced as soon as possible. Complications such as intracardiac thrombi formation, require targeted treatment. Specific drug therapies targeting Influenza A have no proven benefit in myocarditis.
| S-EPMC8874847 | biostudies-literature