Cardiogenic shock treated with immunosuppression: a case presentation of acute fulminant eosinophilic myocarditis

Eosinophilic Myocarditis is a rapidly progressive form of myocarditis, associated with several underlying conditions including inflammatory bowel disease. A 34-year old male with a history of Ulcerative Colitis on Infliximab presented with chest pain, dyspnoea and a recent febrile illness. Serum troponin levels were raised and ECG showed right bundle brunch block. Subsequent emergency coronary angiography showed unobstructed coronary arteries but echocardiography revealed severely impaired left ventricular function. He clinically deteriorated rapidly, developing atrio-ventricular block and cardiogenic shock requiring inotropic and mechanical circulatory support. Endomyocardial biopsy specimens showed diffuse eosinophilic infiltration. Aggressive corticosteroid therapy was initiated and there was a gradual resolution of ventricular function. Peripheral eosinophil counts were within the normal range throughout the illness. Disease activity was monitored with multimodality imaging including PET-CT. Immunosuppression was maintained with Ciclosporin and Mycophenolate Mofetil, avoiding long-term steroid therapy.