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June 23, 2023CureusOpen Access

Unconventional Approach: Steroid Treatment for Eosinophilic Myocarditis Despite Negative Endomyocardial Biopsy

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Key result

Empiric IV steroids improve LVEF by ~10% in a patient with suspected biopsy-negative eosinophilic myocarditis.

  • n=1

Why the study?

Eosinophilic myocarditis is difficult to diagnose even with endomyocardial biopsy due to patchy myocardial infiltration, complicating treatment decisions.

Does empiric high-dose intravenous steroid treatment improve symptoms and cardiac function in suspected eosinophilic myocarditis with negative biopsy?

Comparison

Empiric high-dose intravenous steroids after negative endomyocardial biopsy

Design

Case report

Authors

MVMichael VaysblatSBSuhwoo BaeBPBeatrice Panjwani

Discussion

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Member takes

Overview

May support empiric steroids despite negative biopsy in suspected eosinophilic myocarditis; leaves open efficacy pending prospective data.

Study Design

Type

Case Report (n=1)

Multicenter

No

Structured PICO

Does empiric high-dose intravenous steroid treatment improve symptoms and cardiac function in suspected eosinophilic myocarditis with negative biopsy?

P
Population
A 43-year-old female with a history of nonischemic cardiomyopathy who developed idiopathic eosinophilic myocarditis complicated by cardiac arrest.
I
Intervention
Empiric high-dose intravenous steroids
O
Outcome
Improvement in symptoms and cardiac function

Empiric high-dose steroid therapy may be beneficial and life-saving in suspected eosinophilic myocarditis even when endomyocardial biopsy is negative due to patchy infiltration.

Limitations

  • Endomyocardial biopsy failed to provide a definitive diagnosis, likely due to focal infiltration and low sensitivity.
  • Lack of specific criteria for diagnosing eosinophilic myocarditis makes definitive diagnosis challenging.
  • Single case report limits generalizability of the findings.

Cite This Study

Vaysblat et al. (2023) conducted a case report in Eosinophilic myocarditis (n=1). Intravenous methylprednisolone was evaluated on Left ventricular ejection fraction (LVEF). Empiric treatment with high-dose intravenous steroids improved left ventricular ejection fraction from 30% to 40% in a patient with suspected eosinophilic myocarditis despite a negative endomyocardial biopsy.

synapsesocial.com/papers/6ab0eb628fab34038e364d40https://doi.org/10.7759/cureus.40845
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Also Consider

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

  1. 1The Clinicopathological Profile of Eosinophilic Myocarditis2018 · 37 citations
  2. 2Diagnosis and treatment of eosinophilic myocarditis2021 · 61 citations
  3. 3The State of the Heart Biopsy: A Clinical Review2020 · 44 citations
  4. 4Acute Necrotizing Eosinophilic Myocarditis as a Manifestation of Severe Hypersensitivity Myocarditis1991 · 68 citations
  5. 5Current state of knowledge on aetiology, diagnosis, management, and therapy of myocarditis: a position statement of the European Society of Cardiology Working Group on Myocardial and Pericardial Diseases2013 · 3,502 citations