Clinical Features and Outcomes of Eosinophilic Myocarditis Patients Treated with Prednisolone at a Single Institution Over a 27-Year Period

Sayaka Kawano; Johji Kato; Noriaki Kawano; Yuki Yoshimura; Hiroyuki Masuyama; Takashi Fukunaga; Yuichiro Sato; Haruhiko Maruyama; Kenroh Mihara; Akira Ueda; Kiyokazu Toyoda; Takuroh Imamura; Kazuo Kitamura

doi:10.2169/internalmedicine.50.4079

ORIGINAL ARTICLES

Clinical Features and Outcomes of Eosinophilic Myocarditis Patients Treated with Prednisolone at a Single Institution Over a 27-Year Period

Sayaka Kawano, Johji Kato, Noriaki Kawano, Yuki Yoshimura, Hiroyuki Masuyama, Takashi Fukunaga, Yuichiro Sato, Haruhiko Maruyama, Kenroh Mihara, Akira Ueda, Kiyokazu Toyoda, Takuroh Imamura, Kazuo Kitamura

Author information

Sayaka Kawano
Department of Internal Medicine, Circulatory and Body Fluid Regulation, Faculty of Medicine, University of Miyazaki, Japan
Johji Kato
Frontier Science Research Center, University of Miyazaki, Japan
Noriaki Kawano
Department of Internal Medicine, Miyazaki Prefectural Hospital, Japan
Yuki Yoshimura
Department of Cardiology, Miyazaki Prefectural Hospital, Japan
Hiroyuki Masuyama
Department of Cardiology, Miyazaki Prefectural Hospital, Japan
Takashi Fukunaga
Department of Cardiology, Miyazaki Prefectural Hospital, Japan
Yuichiro Sato
Department of Pathology, Faculty of Medicine, University of Miyazaki, Japan
Haruhiko Maruyama
Department of Parasitology, Faculty of Medicine, University of Miyazaki, Japan
Kenroh Mihara
Department of Clinical Laboratory, Miyazaki Prefectural Hospital, Japan
Akira Ueda
Department of Internal Medicine, Miyazaki Prefectural Hospital, Japan
Kiyokazu Toyoda
Department of Surgery, Miyazaki Prefectural Hospital, Japan
Takuroh Imamura
Department of Internal Medicine, Circulatory and Body Fluid Regulation, Faculty of Medicine, University of Miyazaki, Japan
Kazuo Kitamura
Department of Internal Medicine, Circulatory and Body Fluid Regulation, Faculty of Medicine, University of Miyazaki, Japan

Keywords: eosinophilic myocarditis, eosinophilic cationic protein, parasitic infection, FIP1 L1-PDGFRα fusion gene, prednisolone

JOURNAL OPEN ACCESS

2011 Volume 50 Issue 9 Pages 975-981

DOI https://doi.org/10.2169/internalmedicine.50.4079

Details

Abstract

Background Eosinophilic myocarditis is a rare clinical entity characterized by eosinophilia and myocardial inflammation with infiltrating eosinophils. The prognosis of patients with eosinophilic myocarditis is difficult to determine due the disease's rarity and varied causes; consequently, standard treatment has not been established.
Objective To elucidate the clinical characteristics and treatment outcome of eosinophilic myocarditis, we retrospectively studied 7 patients fulfilling the criteria of the Japanese Circulation Society for eosinophilic myocarditis from among 64 patients admitted to our institution with eosinophilia over a 27-year period.
Results The patients' ages at diagnosis ranged from 36 to 83 years (median: 52 years). The etiologies of the eosinophilic myocarditis were found to be idiopathic (3 patients), Churg-Strauss syndrome (2 patients), parasitic infection (1 patient) and chronic eosinophilic leukemia (CEL) (1 patient). In addition to treatment for the underlying disease, we also administered prednisolone at a dose appropriate to the disease severity (6 of 7 patients). The patient who was diagnosed with a parasitic infection was treated only with albendazole, because eosinophilic myocarditis was mild. The patient with CEL was positive for the FIP1 L1-PDGFRα fusion gene and was treated with imatinib. Eosinophilic cationic protein was a useful marker for assessing disease activity and treatment efficacy. At the end of the study, of the seven patients treated, six were alive (86%), giving a mean survival time of 37 ± 40 months (mean ± SD).
Conclusion Because eosinophilic myocarditis has various etiologies, it is essential to identify the etiology of the underlying disease. In the majority of eosinophilic myocarditis patients, administration of prednisolone may be an effective therapeutic modality producing a good outcome.

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