Acute necrotizing eosinophilic myocarditis possibly triggered by an antimigraine drug as an uncommon cause of acute heart failure: a case report. Issue 8 (9th August 2021)

• Record Type: Journal Article
• Authors: Beck-da-Silva, Luís; Maulaz, Alexandre; Schvartzman, Paulo; Oliveira, Francine Hehn; Stifft, Jonathas; Astigarraga, Claudia; Kronfeld, Matias
• Editors: Rudzínski, Piotr Nikodem; Galyavich, Albert; Nistor, Dan Octavian; Tardo, Daniel; Vervaat, Fabienne
• Is Part Of: European heart journal. Volume 5:Issue 8(2021)
• Publication Date: 2021-08-09
• Subjects: Case report -- Myocarditis -- Acute heart failure -- ANEM -- Migraine; Cardiology -- Periodicals; Cardiology -- Case studies -- Periodicals; Heart -- Diseases -- Periodicals; Heart -- Diseases -- Case studies -- Periodicals; 616.12
• DOI: 10.1093/ehjcr/ytab286
• Languages: English
• ISSNs: 2514-2119

Abstract

Abstract: Background: Epigastric or chest pain with an abnormal electrocardiogram (ECG) in a young, otherwise healthy patient should trigger an investigation to rule out myocarditis. The myocarditis covers a wide spectrum of severity. The search for the aetiologic factor could be definitive for the success of therapy. Case summary: A previously healthy 29-year-old woman presented to the Emergency Room with epigastric pain, eosinophilia, and an abnormal ECG. A thorough evaluation including cardiac magnetic resonance and endomyocardial biopsy was undertaken. A diagnosis of acute necrotizing eosinophilic myocarditis was made. Discussion: The case is particularly unique for its suspected predisposing trigger: an antimigraine drug. A possible systemic hypersensitivity reaction, reflected by the occurrence of concomitant severe serum eosinophilia, acute myocarditis, and central nervous system vasculitis, was successfully treated with steroids, further supporting the diagnosis.