Advertisement

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
  • 79 Downloads

Sirs:

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.

Notes

Compliance with ethical standards

Conflict of interest

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

References

  1. 1.
    Brambatti M, Matassini MV, Adler ED, Klingel K, Camici PG, Ammirati E (2017) Eosinophilic myocarditis: characteristics, treatment, and outcomes. J Am Coll Cardiol 70(19):2363–2375CrossRefGoogle Scholar
  2. 2.
    Kuchynka P, Palecek T, Masek M, Cerny V, Lambert L, Vitkova I (2016) Current diagnostic and therapeutic aspects of eosinophilic myocarditis. Biomed Res Int 2016:1–6CrossRefGoogle Scholar
  3. 3.
    Al Ali AM, Straatman LP, Allard MF, Ignaszewski AP (2006) Eosinophilic myocarditis: case series and review of literature. Can J Cardiol 22(14):1233–1237CrossRefGoogle Scholar
  4. 4.
    Yanagisawa T, Inomata T, Watanabe I, Maekawa E, Mizutani T, Shinagawa H (2011) Clinical significance of corticosteroid therapy for eosinophilic myocarditis. Int Heart J 52(2):110–113CrossRefGoogle Scholar
  5. 5.
    Morimoto S, Kubo N, Hiramitsu S, Uemura A, Ohtsuki M, Kato S (2003) Changes in the peripheral eosinophil count in patients with acute eosinophilic myocarditis. Heart Vessels 18(4):193–196CrossRefGoogle Scholar
  6. 6.
    Fozing T, Zouri N, Tost A, Breit R, Seeck G, Koch C (2014) Management of a patient with eosinophilic myocarditis and normal peripheral eosinophil count: case report and literature review. Circ Heart Fail 7(4):692–694CrossRefGoogle Scholar
  7. 7.
    Sabatine MS, Poh K-K, Mega JL, Shepard J-AO, Stone JR, Frosch MP (2007) Case 36-2007. N Engl J Med 357(21):2167–2178CrossRefGoogle Scholar
  8. 8.
    Veulemans V, Hellhammer K, Polzin A, Bönner F, Zeus T, Kelm M (2018) Current and future aspects of multimodal and fusion imaging in structural and coronary heart disease. Clin Res Cardiol Off J Ger Card Soc 107(Suppl 2):49–54CrossRefGoogle Scholar
  9. 9.
    Bekfani T, Westphal F, Schulze PC (2018) Therapeutic options in advanced heart failure. Clin Res Cardiol Off J Ger Card Soc 107(Suppl 2):114–119CrossRefGoogle Scholar
  10. 10.
    Luedde M, Spehlmann ME, Frey N (2018) Progress in heart failure treatment in Germany. Clin Res Cardiol Off J Ger Card Soc 107(Suppl 2):105–113CrossRefGoogle Scholar
  11. 11.
    Maisch B, Pankuweit S (2012) Current treatment options in (peri)myocarditis and inflammatory cardiomyopathy Aktuelle Behandlungsoptionen bei (Peri-)Myokarditis und inflammatorischer Kardiomyopathie. Herz 37(6):644–656CrossRefGoogle Scholar
  12. 12.
    Kawano S, Kato J, Kawano N, Yoshimura Y, Masuyama H, Fukunaga T (2011) Clinical features and outcomes of eosinophilic myocarditis patients treated with prednisolone at a single institution over a 27-year period. Intern Med Tokyo Jpn 50(9):975–981CrossRefGoogle Scholar
  13. 13.
    Shoaib A, Farag M, Nolan J, Rigby A, Patwala A, Rashid M, Kwok CS, Perveen R, Clark AL, Komajda M, Cleland JGF (2018) Mode of presentation and mortality amongst patients hospitalized with heart failure? A report from the first euro heart failure survey. Clin Res Cardiol.  https://doi.org/10.1007/s00392-018-1380-6 Google Scholar
  14. 14.
    Baandrup U (2012) Eosinophilic myocarditis. Herz 37(8):849–852CrossRefGoogle Scholar
  15. 15.
    Escher F, Kühl U, Lassner D, Poller W, Westermann D, Pieske B (2016) Long-term outcome of patients with virus-negative chronic myocarditis or inflammatory cardiomyopathy after immunosuppressive therapy. Clin Res Cardiol Off J Ger Card Soc 105(12):1011–1020CrossRefGoogle Scholar

Copyright information

© 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

Personalised recommendations