Successful Treatment of Acute Eosinophilic Myocarditis due to Eosinophilic Granulomatosis with Polyangiitis in an Older Man, Followed by Dual Single Photon Emission Computed Tomography

Abstract

An 83-year-old man with a 5-month history of asthma presented to the emergency department with chest oppression and dyspnea. Electrocardiography showed ST-segment depression. Transthoracic echocardiography showed no asynergy with an ejection fraction of 62%. Coronary angiography revealed no stenosis. On day 3, he developed worsening dyspnea, cough, and rapidly progressive acute decompensated heart failure with abdominal purpura and lower extremity petechiae.

Myocardial and skin biopsies revealed eosinophilic infiltration. He was diagnosed with acute eosinophilic myocarditis and heart failure due to eosinophilic granulomatosis with polyangiitis. Methylprednisolone pulse therapy dramatically improved his symptoms and congestion. Dual single-photon emission computed tomography after 1 year demonstrated lesion improvement.