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.
Details
State: Public
Version: Final published version
License: CC BY-NC 4.0
Serval ID
serval:BIB_395C5797ED4A
Type
Article: article from journal or magazin.
Publication sub-type
Case report (case report): feedback on an observation with a short commentary.
Collection
Publications
Institution
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.
Journal
European heart journal. Case reports
ISSN
2514-2119 (Electronic)
ISSN-L
2514-2119
Publication state
Published
Issued date
04/2023
Peer-reviewed
Oui
Volume
7
Number
4
Pages
ytad185
Language
english
Notes
Publication types: Case Reports
Publication Status: epublish
Publication Status: epublish
Abstract
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).
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.
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.
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.
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.
Keywords
Acute myeloid leukaemia, Cardiac MRI, Case report, Eosinophilic myocarditis
Pubmed
Web of science
Open Access
Yes
Create date
08/05/2023 11:41
Last modification date
09/08/2024 15:57