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September 15, 2026European Heart Journal Supplements

Eosinophilic Myocarditis: Diagnostic Pitfalls and Therapeutic Challenges. A Case Series

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Key result

IL-5 biologics and corticosteroids normalize LVEF and enable steroid withdrawal in 4 cases.

  • n=4

Why the study?

Eosinophilic myocarditis is rare and life-threatening, with diagnosis hindered by heterogeneous presentations, overlapping imaging phenotypes, suboptimal biopsy timing, and the misconception that it requires peripheral eosinophilia.

Population

Four eosinophilic myocarditis cases

Design

Case series

Authors

CMC MenghiAGA GiordaniABA Baritussio

Discussion

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Overview

Supports IL-5 biologics for eosinophilic myocarditis; hypothesis-generating from case reports and should not yet change practice.

Key Points

  • Evaluate the clinical features, diagnostic pitfalls, and therapeutic outcomes of patients presenting with eosinophilic myocarditis.
  • Clinical assessment and longitudinal tracking of four patients (N=4) with eosinophilic myocarditis across diverse clinical contexts.
  • Diagnostic workup included cardiovascular magnetic resonance imaging, assessment of peripheral eosinophil counts, and serial endomyocardial biopsies.
  • Therapies administered included systemic corticosteroids combined with azathioprine or the targeted anti-interleukin-5 monoclonal antibody mepolizumab.
  • Endomyocardial biopsy findings were masked by active steroid therapy in two cases, initially appearing as lymphocytic or polymorphous infiltrates before eosinophilic involvement was confirmed upon steroid tapering.
  • Misclassification occurred on cardiovascular magnetic resonance in one patient due to apical pseudohypertrophy, leading to delayed diagnosis, endomyocardial fibrosis, and mitral annuloplasty.
  • Targeted anti-interleukin-5 biologic therapy or azathioprine prevented relapses, normalized left ventricular ejection fraction and cardiac biomarkers, and facilitated complete corticosteroid withdrawal.

Study Design

Type

Case Report (n=4)

Structured PICO

P
Population
Four cases of eosinophilic myocarditis highlighting distinct diagnostic and therapeutic challenges.
E
Exposure
Corticosteroids with azathioprine (1 case) or long-term anti-IL-5 monoclonal antibodies (mepolizumab) (3 cases)
O
Outcome
Treatment tolerability, EM relapses, corticosteroid withdrawal, control of peripheral eosinophilia, NYHA class, LVEF, and cardiac biomarkers

Targeted IL-5 pathway biologics such as mepolizumab offer a promising, well-tolerated treatment option for eosinophilic myocarditis, facilitating corticosteroid withdrawal and cardiac recovery.

Cite This Study

Menghi et al. (2026) conducted a case report in Eosinophilic myocarditis (n=4). Corticosteroids and targeted IL-5 pathway biologics (mepolizumab) was evaluated on Clinical outcomes including corticosteroid withdrawal, control of peripheral eosinophilia, improved NYHA class, and normalization of LVEF. Treatment with corticosteroids and targeted IL-5 pathway biologics (mepolizumab) was well tolerated, enabled corticosteroid withdrawal, and normalized left ventricular ejection fraction in 4 cases.

synapsesocial.com/papers/6aa9017deed42882c1fc18dehttps://doi.org/10.1093/eurheartjsupp/suag058.400
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Eosinophilic myocarditis: diagnostic pitfalls and therapeutic challenges. A Case Series2026
  2. 2Unmasking Eosinophilic Myocarditis: Importance of Multimodality Imaging and Histological Confirmation in a Challenging Case2026
  3. 3Eosinophilic myocarditis: case series and review of the literature.2025 · 1 citations
  4. 4Eosinophilic myocarditis: systematic review2023 · 20 citations
  5. 5Unconventional Approach: Steroid Treatment for Eosinophilic Myocarditis Despite Negative Endomyocardial Biopsy2023