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Eosinophilic myocarditis during treatment of acute myeloid leukaemia: cardiac magnetic resonance in the very early phase mimicking triple-vessel coronary artery disease: a case report

BACKGROUND: Chemotherapy of acute myeloid leukaemia (AML) can cause a broad spectrum of cardiotoxic effects. Cardiac magnetic resonance (CMR) is key for the diagnosis of eosinophilic myocarditis (EM) defined by the presence of sub-endocardial necrosis and fibrosis. This case report describes the pic...

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Autores principales: Salihu, Adil, Stadelmann, Raphael, Solimando, Emilie, Schwitter, Juerg
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10141456/
https://www.ncbi.nlm.nih.gov/pubmed/37123659
http://dx.doi.org/10.1093/ehjcr/ytad185
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author Salihu, Adil
Stadelmann, Raphael
Solimando, Emilie
Schwitter, Juerg
author_facet Salihu, Adil
Stadelmann, Raphael
Solimando, Emilie
Schwitter, Juerg
author_sort Salihu, Adil
collection PubMed
description BACKGROUND: Chemotherapy of acute myeloid leukaemia (AML) can cause a broad spectrum of cardiotoxic effects. Cardiac magnetic resonance (CMR) is key for the diagnosis of eosinophilic myocarditis (EM) defined by the presence of sub-endocardial necrosis and fibrosis. This case report describes the picture of severe triple-vessel ischaemia due to infiltration of eosinophilia without atherosclerotic coronary artery disease (CAD). CASE SUMMARY: A 57-year-old woman was diagnosed with AML requiring chemotherapy. Three days after initiation of chemotherapy, the patient presented with chest pain and new left ventricular (LV) dysfunction and hyper-eosinophilia. A CMR examination initially was compatible with severe triple-vessel ischaemia. Tissue characterization by CMR was not done due to severe dyspnoea promoting the differential diagnosis of triple-vessel CAD or chemotherapy-induced triple-vessel coronary spasm. However, invasive coronary angiography excluded obstructive CAD. Severe LV dysfunction and troponin elevation persisted arguing against coronary vasospasm. Chemotherapy induced a massive increase in blood eosinophils, and EM was considered as most likely diagnosis. Immunosuppressive treatment improved the patient’s status and a CMR later on confirmed the diagnosis of EM. DISCUSSION: Chemotherapy-induced massive eosinophilia can cause widespread coronary micro-vascular infiltration mimicking severe triple-vessel CAD. Early CMR did not evaluate tissue composition, and EM was not considered which delayed adequate treatment. A complete CMR assessment is key to establish the correct diagnosis.
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spelling pubmed-101414562023-04-29 Eosinophilic myocarditis during treatment of acute myeloid leukaemia: cardiac magnetic resonance in the very early phase mimicking triple-vessel coronary artery disease: a case report Salihu, Adil Stadelmann, Raphael Solimando, Emilie Schwitter, Juerg Eur Heart J Case Rep Case Report BACKGROUND: Chemotherapy of acute myeloid leukaemia (AML) can cause a broad spectrum of cardiotoxic effects. Cardiac magnetic resonance (CMR) is key for the diagnosis of eosinophilic myocarditis (EM) defined by the presence of sub-endocardial necrosis and fibrosis. This case report describes the picture of severe triple-vessel ischaemia due to infiltration of eosinophilia without atherosclerotic coronary artery disease (CAD). CASE SUMMARY: A 57-year-old woman was diagnosed with AML requiring chemotherapy. Three days after initiation of chemotherapy, the patient presented with chest pain and new left ventricular (LV) dysfunction and hyper-eosinophilia. A CMR examination initially was compatible with severe triple-vessel ischaemia. Tissue characterization by CMR was not done due to severe dyspnoea promoting the differential diagnosis of triple-vessel CAD or chemotherapy-induced triple-vessel coronary spasm. However, invasive coronary angiography excluded obstructive CAD. Severe LV dysfunction and troponin elevation persisted arguing against coronary vasospasm. Chemotherapy induced a massive increase in blood eosinophils, and EM was considered as most likely diagnosis. Immunosuppressive treatment improved the patient’s status and a CMR later on confirmed the diagnosis of EM. DISCUSSION: Chemotherapy-induced massive eosinophilia can cause widespread coronary micro-vascular infiltration mimicking severe triple-vessel CAD. Early CMR did not evaluate tissue composition, and EM was not considered which delayed adequate treatment. A complete CMR assessment is key to establish the correct diagnosis. Oxford University Press 2023-04-17 /pmc/articles/PMC10141456/ /pubmed/37123659 http://dx.doi.org/10.1093/ehjcr/ytad185 Text en © The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. https://creativecommons.org/licenses/by-nc/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (https://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Case Report
Salihu, Adil
Stadelmann, Raphael
Solimando, Emilie
Schwitter, Juerg
Eosinophilic myocarditis during treatment of acute myeloid leukaemia: cardiac magnetic resonance in the very early phase mimicking triple-vessel coronary artery disease: a case report
title Eosinophilic myocarditis during treatment of acute myeloid leukaemia: cardiac magnetic resonance in the very early phase mimicking triple-vessel coronary artery disease: a case report
title_full Eosinophilic myocarditis during treatment of acute myeloid leukaemia: cardiac magnetic resonance in the very early phase mimicking triple-vessel coronary artery disease: a case report
title_fullStr Eosinophilic myocarditis during treatment of acute myeloid leukaemia: cardiac magnetic resonance in the very early phase mimicking triple-vessel coronary artery disease: a case report
title_full_unstemmed Eosinophilic myocarditis during treatment of acute myeloid leukaemia: cardiac magnetic resonance in the very early phase mimicking triple-vessel coronary artery disease: a case report
title_short Eosinophilic myocarditis during treatment of acute myeloid leukaemia: cardiac magnetic resonance in the very early phase mimicking triple-vessel coronary artery disease: a case report
title_sort eosinophilic myocarditis during treatment of acute myeloid leukaemia: cardiac magnetic resonance in the very early phase mimicking triple-vessel coronary artery disease: a case report
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10141456/
https://www.ncbi.nlm.nih.gov/pubmed/37123659
http://dx.doi.org/10.1093/ehjcr/ytad185
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