Eosinophilic Myocarditis due to Churg-Strauss Syndrome With Markedly Elevated Eosinophil Cationic Protein

Tomoya Hara; Koji Yamaguchi; Takashi Iwase; Muneyuki Kadota; Mika Bando; Kozue Ogasawara; Sachiko Bando; Takayuki Ise; Toshiyuki Niki; Yuka Ueda; Noriko Tomita; Yoshio Taketani; Hirotsugu Yamada; Takeshi Soeki; Tetsuzo Wakatsuki; Masataka Sata

doi:10.1536/ihj.54.51

Case Reports

Eosinophilic Myocarditis due to Churg-Strauss Syndrome With Markedly Elevated Eosinophil Cationic Protein

Tomoya Hara, Koji Yamaguchi, Takashi Iwase, Muneyuki Kadota, Mika Bando, Kozue Ogasawara, Sachiko Bando, Takayuki Ise, Toshiyuki Niki, Yuka Ueda, Noriko Tomita, Yoshio Taketani, Hirotsugu Yamada, Takeshi Soeki, Tetsuzo Wakatsuki, Masataka Sata

Author information

Tomoya Hara
Department of Cardiovascular Medicine, Institute of Health Biosciences, The University of Tokushima Graduate School
Koji Yamaguchi
Department of Cardiovascular Medicine, Institute of Health Biosciences, The University of Tokushima Graduate School
Takashi Iwase
Department of Cardiovascular Medicine, Institute of Health Biosciences, The University of Tokushima Graduate School
Muneyuki Kadota
Department of Cardiovascular Medicine, Institute of Health Biosciences, The University of Tokushima Graduate School
Mika Bando
Department of Cardiovascular Medicine, Institute of Health Biosciences, The University of Tokushima Graduate School
Kozue Ogasawara
Department of Cardiovascular Medicine, Institute of Health Biosciences, The University of Tokushima Graduate School
Sachiko Bando
Department of Cardiovascular Medicine, Institute of Health Biosciences, The University of Tokushima Graduate School
Takayuki Ise
Department of Cardiovascular Medicine, Institute of Health Biosciences, The University of Tokushima Graduate School
Toshiyuki Niki
Department of Cardiovascular Medicine, Institute of Health Biosciences, The University of Tokushima Graduate School
Yuka Ueda
Department of Cardiovascular Medicine, Institute of Health Biosciences, The University of Tokushima Graduate School
Noriko Tomita
Department of Cardiovascular Medicine, Institute of Health Biosciences, The University of Tokushima Graduate School
Yoshio Taketani
Department of Cardiovascular Medicine, Institute of Health Biosciences, The University of Tokushima Graduate School
Hirotsugu Yamada
Department of Cardiovascular Medicine, Institute of Health Biosciences, The University of Tokushima Graduate School
Takeshi Soeki
Department of Cardiovascular Medicine, Institute of Health Biosciences, The University of Tokushima Graduate School
Tetsuzo Wakatsuki
Department of Cardiovascular Medicine, Institute of Health Biosciences, The University of Tokushima Graduate School
Masataka Sata
Department of Cardiovascular Medicine, Institute of Health Biosciences, The University of Tokushima Graduate School

Keywords: Heart failure, Inflammation

JOURNAL FREE ACCESS

2013 Volume 54 Issue 1 Pages 51-53

DOI https://doi.org/10.1536/ihj.54.51

Details

Abstract

A 67-year-old woman with asthma visited our hospital with increasing dyspnea and new-onset paresthesia and purpura in her legs. Physical examination showed a wheeze, pretibial edema, and surrounding purpura. Chest X-rays showed cardiac decompensation and an electrocardiogram revealed a new ST-T change. Laboratory data showed leukocytosis, hypereosinophilia (10,450/μL), troponin T(+), elevated BNP, and markedly elevated eosinophil cationic protein (ECP) (> 150 ng/mL). Echocardiography revealed diffuse left ventricular hypokinesis (ejection fraction 30%) with increased wall thickness. Coronary angiography was normal. Cardiac magnetic resonance imaging implied diffuse myocardial edema and subendocardial late gadolinium enhancement. Skin biopsy of purpura showed superfi cial perivascular dermatitis with remarkable eosinophilic infiltrations. No evidence of drug allergies, parasitic infection, or myeloproliferative disorder was detected. Based on these findings, a diagnosis of eosinophilic myocarditis due to Churg-Strauss syndrome was considered. She was administered prednisolone at a dose of 1 mg/kg, cyclophosphamide, and diuretics. Several markers of eosinophilic myocarditis and heart failure gradually improved, including ECP. She was discharged 30 days later with no cardiac event. Eosinophilic myocarditis is characterized by predominantly eosinophilic infi ltration. Eosinophilic granule proteins, such as ECP and major basic protein, play important roles in the pathogenesis of eosinophilic myocarditis. We experienced a rare case of eosinophilic myocarditis due to Churg-Strauss syndrome. Markedly elevated ECP played an important role in the early diagnosis and subsequent reduction in ECP served as a marker of monitoring. In an asthmatic patient with dyspnea, hypereosinophilia, and vasculitis, Churg-Strauss syndrome with eosinophilic myocarditis should be considered.

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