What is the clinical evidence from this study?

Study design: Case Report. Population: Ulcerative colitis and eosinophilic myocarditis (n=1). Intervention: Sequential biologic therapy and corticosteroid withdrawal. Primary outcome: Development of cardiogenic shock and eosinophilic myocarditis.

What question did this study set out to answer?

This case focuses on the development of eosinophilic myocarditis in a patient receiving sequential biologic therapy for ulcerative colitis.

June 19, 2026JACC Case Reports0 citationsOpen Access

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Fulminant Eosinophilic Myocarditis After Sequential Biologic Therapy in Ulcerative Colitis

JLJinyoung LeeSamsung Medical Center DKDarae KimSamsung Medical Center DHDavid HongSamsung Medical Center

Key Result

Sequential biologic therapy and corticosteroid withdrawal in a 35-year-old man with ulcerative colitis was temporally associated with fulminant eosinophilic myocarditis and cardiogenic shock.

Key Points

This case focuses on the development of eosinophilic myocarditis in a patient receiving sequential biologic therapy for ulcerative colitis.
Case report of a 35-year-old man with ulcerative colitis.
Sequential biologic therapy, including vedolizumab, followed by corticosteroid withdrawal.
Endomyocardial biopsy confirmed eosinophilic myocarditis.
Patient presented with cardiogenic shock and severe biventricular dysfunction (LVEF 10%).
Eosinophil count was elevated at 2,154/μL, with coronary angiography showing no obstructive disease.
Recovery of left ventricular function followed treatment with veno-arterial ECMO and mepolizumab.

Study Design

Type

Case Report (n=1)

Structured PICO

Population

A 35-year-old man with ulcerative colitis who developed cardiogenic shock due to eosinophilic myocarditis after sequential biologic therapy and corticosteroid withdrawal.

Exposure

Veno-arterial extracorporeal membrane oxygenation (VA-ECMO), high-dose intravenous methylprednisolone, and mepolizumab

Outcome

Recovery of left ventricular function

In patients with inflammatory bowel disease receiving biologics, hypereosinophilia with acute heart failure should prompt evaluation for eosinophilic myocarditis, which may respond to early biopsy-guided targeted immunomodulatory therapy.

Abstract

BACKGROUND: Eosinophilic myocarditis has heterogeneous presentations and may cause fulminant cardiogenic shock. CASE SUMMARY: A 35-year-old man with ulcerative colitis and eosinophilia developed cardiogenic shock after sequential biologic therapy (most recently vedolizumab) and corticosteroid withdrawal. He rapidly deteriorated with severe biventricular dysfunction (left ventricular ejection fraction 10%) and hypereosinophilia (eosinophil count 2,154/μL). Coronary angiography showed no obstructive disease, and cardiac magnetic resonance suggested diffuse myocardial involvement. Endomyocardial biopsy confirmed eosinophilic myocarditis. He required veno-arterial extracorporeal membrane oxygenation and high-dose intravenous methylprednisolone. Recurrent eosinophilia during tapering prompted use of mepolizumab, followed by recovery of left ventricular function. DISCUSSION: Biologic exposure with corticosteroid withdrawal was temporally associated with systemic eosinophilic activation, and histologic confirmation by biopsy enabled escalation to targeted therapy. TAKE-HOME MESSAGES: In patients with inflammatory bowel disease receiving biologics, hypereosinophilia with acute heart failure should prompt evaluation for eosinophilic myocarditis. Early biopsy may enable timely escalation to targeted immunomodulatory therapy.

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Fulminant Eosinophilic Myocarditis After Sequential Biologic Therapy in Ulcerative Colitis

Key Result

Key Points

Study Design

Structured PICO

Abstract

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