Fulminant Eosinophilic Myocarditis

Figure 1. Main Findings on Initial Work-Up in the ED (A) Electrocardiography. (B) Chest radiography. (C) Transthoracic echocardiography. (D) Re-evaluation transthoracic echocardiography showing very low cardiac output. Dopp = Doppler; ED = emergency department; Env Ti = envelope time; HR = heart rate; LVCO = left ventricular cardiac output; LVOT = left ventricular outflow tract; LVSV = left ventricular stroke volume; maxPG = maximum pressure gradient; meanPG = mean pressure gradient; Vmax = maximum velocity; Vmean = mean velocity; VTI = velocity time integral.

Figure 2. Comparison of Admission and Re-Evaluation Chest CT (A) Bilateral ground-glass lung infiltrates. (B) Resolution of lung infiltrates. CT = computed tomography.

Figure 3. Eosinophilic Myocarditis on EMB (H&E, 400×) (A) Severe myocardial necrosis (asterisk) with destruction of myocytes and adjacent normal myocardium (arrow). (B and C) Perivascular spaces with mixed inflammatory infiltrate consisting almost entirely of eosinophils (arrows). (C) Interstitial spaces with edema and eosinophils (arrows). EMB = endomyocardial biopsy; H&E = hematoxylin and eosin.

Figure 4. CMR Findings (A and B) Widespread subendocardial late gadolinium enhancement (arrows) on cardiac magnetic resonance (CMR).

Figure 5. ECMO Management Algorithm ECMO = extracorporeal membrane oxygenation; GDMT = guideline-directed medical therapy; HFrEF = heart failure with reduced ejection fraction; LVAD = left ventricular assist device.