Key result
Methylprednisolone pulse therapy rapidly resolves acute EGPA eosinophilic myocarditis, showing sustained SPECT recovery at 1 year.
Why the study?
Acute eosinophilic myocarditis due to eosinophilic granulomatosis with polyangiitis in older patients is rare and treatment outcomes need documentation.
Case Report (n=1)
No
High-dose intravenous methylprednisolone pulse therapy successfully treated acute fulminant eosinophilic myocarditis due to EGPA, with TL-BMIPP SPECT proving useful for monitoring recovery.
May support steroid pulse in EGPA myocarditis; hypothesis-generating and should not yet change practice.
An 83-year-old man with a 5-month history of asthma presented to the emergency department with chest oppression and dyspnea. Electrocardiography showed ST-segment depression. Transthoracic echocardiography showed no asynergy with an ejection fraction of 62%. Coronary angiography revealed no stenosis. On day 3, he developed worsening dyspnea, cough, and rapidly progressive acute decompensated heart failure with abdominal purpura and lower extremity petechiae.Myocardial and skin biopsies revealed eosinophilic infiltration. He was diagnosed with acute eosinophilic myocarditis and heart failure due to eosinophilic granulomatosis with polyangiitis. Methylprednisolone pulse therapy dramatically improved his symptoms and congestion. Dual single-photon emission computed tomography after 1 year demonstrated lesion improvement.
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Inage et al. (2024) conducted a case report in Acute eosinophilic myocarditis due to eosinophilic granulomatosis with polyangiitis (n=1). Methylprednisolone pulse therapy was evaluated on Clinical improvement and lesion recovery. Methylprednisolone pulse therapy dramatically improved symptoms and congestion in an 83-year-old man with acute eosinophilic myocarditis due to EGPA, with lesion improvement seen on SPECT at 1 year.
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