Acute Severe Myocarditis in a Woman with Hypereosinophilic Syndrome

A 48-year-old woman who had cough attacks and dyspnea for the past year was diagnosed as having asthma bronchial. Computerized tomography, showed cystic bronchiectasis at the left lung lower lobe. No specific findings existed at bronchoscopy and bronchoalveolar lavage. Since Medical treatment did not provide amelioration of symptoms left lower lobectomy was carried out. One month later, the patient was admitted with clinical findings of congestive heart failure. There was wide QRS tachycardia at ECG. Troponin T level was above 2 ng/ml. White blood cell count was 19500/mm3 and eosinophil was 11920/mm3. After cessation of tachycardia by using lidocaine, there was right bundle branch-block, precordial Q waves and poor R wave progression at ECG on following days. Severe hypokinesia on anterior wall, moderate mitral insufficiency, moderate systolic dysfunction, mild pericardial effusion and severe pulmonary hypertension were present at echocardiographic investigation. Heparin, aspirin, nitroglycerin, furosemide, losartan and digoxine was given to the patient. The investigations about parasitic infections and collagen-vascular disease were negative. The patient was diagnosed as having idiopathic hypereosinophilic syndrome and methylprednisolone was given at a dose of 40 mg/day, followed by amelioration of findings. Coronary arteries were found normal but anterolateral hypokinesia and apical akinesia were found. Two months later at control echocardiography, systolic function was better than previous examination and systolic pulmonary artery pressure was found to be lower. This represents a rare development of acute severe myocarditis in a patient with hypereosinophilic syndrome, we decided to report this case.