title: Therapeutic role of pericardiocentesis for acute necrotizing eosinophilic myocarditis with cardiac tamponade.
abstract: 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.
authors.affiliation: Division of Cardiology, Hematology and Endocrinology/ Metabolism Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.
authors.forename: Ryu
authors.initials: R
authors.lastname: Kazama
authors.forename: Yuji
authors.initials: Y
authors.lastname: Okura
authors.forename: Makoto
authors.initials: M
authors.lastname: Hoyano
authors.forename: Ken
authors.initials: K
authors.lastname: Toba
authors.forename: Yukie
authors.initials: Y
authors.lastname: Ochiai
authors.forename: Noriko
authors.initials: N
authors.lastname: Ishihara
authors.forename: Takashi
authors.initials: T
authors.lastname: Kuroha
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Yoshida
authors.forename: Osamu
authors.initials: O
authors.lastname: Namura
authors.forename: Masakazu
authors.initials: M
authors.lastname: Sogawa
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Nakamura
authors.forename: Nobuhiko
authors.initials: N
authors.lastname: Yoshimura
authors.forename: Ken
authors.initials: K
authors.lastname: Nishikura
authors.forename: Kiminori
authors.initials: K
authors.lastname: Kato
authors.forename: Haruo
authors.initials: H
authors.lastname: Hanawa
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Tamura
authors.forename: Shinichiro
authors.initials: S
authors.lastname: Morimoto
authors.forename: Makoto
authors.initials: M
authors.lastname: Kodama
authors.forename: Yoshifusa
authors.initials: Y
authors.lastname: Aizawa
mesh_terms: 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