Therapeutic role of pericardiocentesis for acute necrotizing eosinophilic myocarditis with cardiac tamponade.
We describe a patient with acute necrotizing eosinophilic myocarditis who recovered rapidly after pericardial drainage and without corticosteroid therapy. The 25-year- old man was referred to our hospital with suspected acute myocardial infarction on the basis of severe epigastralgia, abnormal Q waves and ST elevation on electrocardiography, and an increase in cardiac enzymes. Echocardiography disclosed pericardial effusion that compressed the right ventricle, left ventricular dysfunction in conjunction with posterolateral hypokinesis, and a thickened ventricular wall but no mural thrombus. The eosinophil count in the peripheral blood was slightly increased. Coronary angiography showed normal arteries and thus prompted an endomyocardial biopsy. The patient was transferred to the intensive care unit with a clinical diagnosis of myocarditis associated with cardiac tamponade. Emergency pericardiocentesis relieved symptoms immediately. The cells in the pericardial effusion were mainly eosinophils; interleukin 5 and interleukin 13 levels were predominantly elevated, and the effusion was drained for 5 days. The biopsy specimen revealed necrotizing eosinophilic myocarditis. Left ventricular function recovered within a week without corticosteroid therapy. No relapse was observed as of 8 months after diagnosis.
Kazama
Ryu
R
Division of Cardiology, Hematology and Endocrinology/ Metabolism Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.
Okura
Yuji
Y
Hoyano
Makoto
M
Toba
Ken
K
Ochiai
Yukie
Y
Ishihara
Noriko
N
Kuroha
Takashi
T
Yoshida
Tsuyoshi
T
Namura
Osamu
O
Sogawa
Masakazu
M
Nakamura
Yuichi
Y
Yoshimura
Nobuhiko
N
Nishikura
Ken
K
Kato
Kiminori
K
Hanawa
Haruo
H
Tamura
Yusuke
Y
Morimoto
Shinichiro
S
Kodama
Makoto
M
Aizawa
Yoshifusa
Y
D000328:Adult; D002305:Cardiac Tamponade / Q000150:complications / Q000209:etiology*; D004802:Eosinophilia / Q000150:complications* / Q000473:pathology; D006801:Humans; D008297:Male; D009205:Myocarditis / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D020519:Pericardiocentesis; D016896:Treatment Outcome