[Eosinophilic endomyocarditis post partum or pregnancy-related cardiomyopathy].
We report the case of a 28-year old asthmatic female patient, who developed an acute heart failure beginning with diarrhea, fever, and dyspnea 5 weeks after delivery. After improvement of all vital functions and dismissal from hospital care unit a marked blood hypereosinophilia, left ventricular congestive heart failure, pericardium effusion and fever up to 40 degrees C followed. Endomycardial, bone marrow and skeletal muscle biopsies and the pericardial fluid showed a marked eosinophilic infiltration or polymyositis, respectively, which could be treated successfully with steroids and azathioprin. During steroid medication cytomegalovirus-associated myocarditis developed and was diagnosed by in situ hybridization. CMV hyperimmunoglobulin treatment (Cytotect, Biotest) was started (2 ml/kg bw on day 1 and 3, and 1 ml/kg on days 5, 7 and 9), which led to the eradication of the residual infiltrate and CMV-DNA in the myocardium. After discontinuation of all medication, eosinophilia and asthma recurred so that immunosuppressive treatment was continued.
Gehrke
D
D
Abteilung Innere Medizin-Kardiologie, Philipps-Universität Marburg.
Herzum
M
M
Schönian
U
U
Klein
H H
HH
Drude
L
L
Mennel
H D
HD
Maisch
B
B
D000328:Adult; D001379:Azathioprine / Q000008:administration & dosage; D001706:Biopsy; D003131:Combined Modality Therapy; D003586:Cytomegalovirus Infections / Q000175:diagnosis / Q000188:drug therapy / Q000473:pathology; D003937:Diagnosis, Differential; D004699:Endocardium / Q000187:drug effects / Q000473:pathology; D005260:Female; D006333:Heart Failure / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology; D006801:Humans; D017681:Hypereosinophilic Syndrome / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology; D007136:Immunoglobulins / Q000008:administration & dosage; D016756:Immunoglobulins, Intravenous; D009205:Myocarditis / Q000175:diagnosis / Q000188:drug therapy / Q000473:pathology; D009206:Myocardium / Q000473:pathology; D009894:Opportunistic Infections / Q000175:diagnosis / Q000188:drug therapy / Q000473:pathology; D011241:Prednisone / Q000008:administration & dosage; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology; D011644:Puerperal Disorders / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology
D007136:Immunoglobulins; D016756:Immunoglobulins, Intravenous; C045781:cytomegalovirus-specific hyperimmune globulin; D001379:Azathioprine; D011241:Prednisone
Eosinophile Endomyokarditis post partum oder Schwangerschaftskardiomyopathie.