Acute necrotizing eosinophilic myocarditis as a manifestation of severe hypersensitivity myocarditis: antemortem diagnosis and successful treatment

Article Abstract:

Two diseases exist that seem to be caused by immune reactions in heart muscle. Acute necrotizing eosinophilic myocarditis begins with severe congestive heart failure, or failure of the heart to pump blood adequately for the body's needs. Most cases have been preceded by viral illnesses, and all reported cases have thus far been fatal. Biopsies of the heart tissue of these patients reveal infiltration by eosinophils and lymphocytes, two categories of white blood cells active in inflammatory and allergic states. Necrosis, or cell death, is also characteristic of biopsies in cases of acute necrotizing eosinophilic myocarditis. The other disease immune-related heart disease is hypersensitivity myocarditis, and results from an allergic reaction to a new drug. Biopsies from patients with this disease also demonstrate infiltrates of eosinophils and lymphocytes, but cell death is rarely seen. A case of nonfatal acute necrotizing myocarditis with some characteristics of hypersensitivity myocarditis is reported. The patient was a 41-year-old woman with a history of systemic lupus erythematosus (an immune disease), which was currently inactive. The woman was given two new drugs, hydroxychloroquine and amitriptyline, and one week later developed severe symptoms of congestive heart failure. A biopsy of her heart muscle was typical of acute necrotizing eosinophilic myocarditis. The two new drugs were stopped, and she was given high doses of steroids to suppress the presumed allergic reaction in her heart muscle. Her condition improved rapidly, and a repeat biopsy two months later showed resolution of the previous necrosis. Unlike most cases of acute necrotizing eosinophilic myocarditis, her illness was temporally related to drugs and not a viral illness. Amitriptyline has been associated with hypersensitivity myocarditis, but not with necrotizing eosinophilic myocarditis. This case report seems to provide support for the theory that the two diseases may represent different ends of a spectrum of the same process. (Consumer Summary produced by Reliance Medical Information, Inc.)

Case studies, Causes of

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The ineffectiveness of immunosuppressive therapy in lymphocytic myocarditis: an overview

Article Abstract:

Immunosuppressive therapy does not appear to be effective in patients with lymphocytic myocarditis. This condition is an inflammation of the heart that is believed to be an autoimmune disease. Consequently, immunosuppressive drugs have been used to treat the disease. Researchers analyzed six reports that evaluated the use of immunosuppressive drugs, including prednisone, azathioprine, cyclosporine, interferon and thymic hormone. Most of the studies found no improvement in heart function after most of these treatments.

Drug therapy, Immunosuppressive agents

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Histologic and cytokine response to immunosuppression in giant-cell myocarditis

Article Abstract:

Giant-cell myocarditis may respond to a drug that suppresses T helper cells. Giant-cell myocarditis is an inflammation of the heart that can cause congestive heart failure. Researchers describe the cases of a 34-year-old women and a 44-year-old man who developed giant-cell myocarditis. Biopsies of the heart muscle revealed that the inflammation was caused by an infiltration of the tissue by T helper cells. The woman was successfully treated with a monoclonal antibody called muromonab-CD3, which blocks these T cells.

Health aspects, Care and treatment, Monoclonal antibodies, Immunotherapy

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