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Myocarditis Mimicking Acute Coronary Syndrome Secondary to Eosinophilia

Aileen DM Divinagracia-Alban and Clavel Macalintal

Background: Eosinophilic myocarditis is a rare and under-recognized subtype of myocarditis. The signs and symptoms are non-specific, most often mimicking other diseases, leading to a late, and sometimes, incorrect diagnosis. This disease can be self-limiting, however, if not detected early, can progress to a fatal outcome.

Case Presentation: A 33-year-old female, known asthmatic was admitted due to recurrent chest pain, dyspnea and abdominal pain. ECGs showed transient ST segment elevation. The cardiac enzymes, WBC and eosinophil counts were significantly elevated. Coronary angiogram was normal. 2D echocardiogram showed concentric hypertrophy with segmental hypokinesia, normal LV EF, severe mitral regurgitation, with signs of diastolic dysfunction. Cardiac MRI showed mild diffuse myocardi10.21767/2471-8505.100060al edema and a patchy subendocardial enhancement. After initiation of steroid therapy, there was dramatic improvement in the symptoms and peripheral eosinophilia. Repeat 2D echocardiogram after several months was normal. Early discontinuation of steroids resulted in recurrence of cardiac events.

Conclusion: Eosinophilic myocarditis, though uncommon, should be considered as a differential diagnosis in patients with acute coronary syndrome-like symptoms, history of asthma and allergies, a normal coronary angiogram, with or without peripheral eosinophilia. An echocardiogram and a cardiac MRI can support the diagnosis, however, endomyocardial biopsy remains to be the gold standard. Prompt recognition and immediate steroid therapy are important keys in managing this rare disease.