Severe eosinophilic myocarditis associated with modafinil in a patient with normal peripheral eosinophil count

  • Marina BäumlEmail author
  • Josefina Udi
  • Karin Klingel
  • Christoph Bode
  • Klaus Warnatz
  • Andreas Zirlik
  • Daniel Duerschmied
  • Paul Biever
Letter to the Editors


Eosinophilic myocarditis (EM) is a rare form of myocardial inflammation characterized by myocardial eosinophilic infiltration [1]. It can lead to a broad spectrum of clinical symptoms, ranging from asymptomatic cases to dramatic and life-threatening progression with rapid myocardial damage and acute heart failure [1, 2, 3, 4]. The etiology is heterogeneous and hypersensitivity or allergic reactions as well as hematological diseases or neoplastic disorders can lead to EM [2]. Eosinophilia in peripheral blood is present in the majority of patients and often suggestive for the diagnosis [1, 5]. EM in the absence of hypereosinophilia, however, is a diagnostic challenge and can lead to a potentially fatal delay in suitable treatment [6]. We present the second description of modafinil-associated acute necrotizing myocarditis after a fatal case, which was published in 2006 [7]. In our case, timely diagnosis by histology and administration of corticosteroid therapy enabled full recovery.


Compliance with ethical standards

Conflict of interest

All authors agreed to submit this case report and declared no conflict of interests.


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© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, Faculty of MedicineUniversity of FreiburgFreiburgGermany
  2. 2.Department of Cardiology and Angiology IUniversity Heart Center Freiburg UniversityFreiburgGermany
  3. 3.Cardiopathology, Institute for PathologyUniversity Hospital TübingenTübingenGermany
  4. 4.Center for Chronic Immunodeficiency, Faculty of MedicineMedical Center - University of FreiburgFreiburgGermany

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