Article
A case series of treating eosinophilic myocarditis with interleukin 5 inhibitors
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Authors
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Antoine Murray
- Klinikum der Ludwig-Maximilians-Universität München, Sektion Rheumatologie und Klinische Immunologie, Medizinische Klinik und Poliklinik IV, München
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Ulrich Grabmaier
- Klinikum der Ludwig-Maximilians-Universität München, Kardiologie, Medizinische Klinik und Poliklinik IV, München
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Delila Singh
- Klinikum der Ludwig-Maximilians-Universität München, Sektion Rheumatologie und Klinische Immunologie, Medizinische Klinik und Poliklinik IV, München
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Andreas Sturm
- Klinikum der Ludwig-Maximilians-Universität München, Sektion Rheumatologie und Klinische Immunologie, Medizinische Klinik und Poliklinik IV, München
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Alla Skapenko
- Klinikum der Ludwig-Maximilians-Universität München, Sektion Rheumatologie und Klinische Immunologie, Medizinische Klinik und Poliklinik IV, München
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Hendrik Schulze-Koops
- Klinikum der Ludwig-Maximilians-Universität München, Sektion Rheumatologie und Klinische Immunologie, Medizinische Klinik und Poliklinik IV, München
| Published: | September 14, 2021 |
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Outline
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Medical history: We report three patients (patient 1: male, aged 45; patient 2: male, aged 58; patient 3: female, aged 74) with cardiac involvement in eosinophilic diseases. Previously diagnosed diseases included eosinophilic asthma in patients 1 and 2 and mild COPD in patient 3.
Course of illness: All three patients presented with shortness of breath, raised inflammatory markers and eosinophils as well as signs of myocarditis including raised troponin markers, creatinine kinase, proNT BNP and abnormal echocardiographs.
Diagnosis: Chest CTs demonstrated atypical pneumonias in patients 1 and 2 while patient 3 show signs of lung fibrosis and congestion. ANCAs were negative in all patients. Peripheral polyneuropathy and pulmonary artery hypertension were also diagnosed in patient 3. In biopsies, patient 2 had eosinophil granulocytes in the bronchial mucosa and lymph nodes whilst patient 3 had eosinophil granulocytes infiltration of the cardiac muscle. Patients 1 and 2 fulfilled the classification criteria for eosinophilic granulomatosis with polyangiitis and patient 3 for hypereosinophilic syndrome. The diagnosis of eosinophilic myocarditis was based on the clinical picture, ECG, blood results, echocardiography as well as cardiac MRI, cardiac biopsy and/or PET CT.
Treatment: Two patients were initially treated with pulse glucocorticoids and then all patients were treated with high dose prednisone. Patient 1 was prescribed a LifeVest due to his low ejection fraction. As patient 1 and 2 both have eosinophilic asthma, Benralizumab was chosen as the first line on-label glucocorticoid-sparing agent. Patient 1 was then later also treated with Azathioprine due to signs of persistent cardiac involvement. Patient 3 had persistent cardiac disease activity despite Mycophenolate-Mofetil (MMF) und Prednisolone and hence MMF was switched to Mepolizumab.
Outcome and Discussion: All 3 patients have tolerated the interleukin 5 inhibitors (IL5i) well and have had no worsening of their condition. Troponin values normalised only in one patient but echocardiography has improved in 2 patients. To our knowledge this is the first case series in the literature assessing the effectiveness of IL5i for treating eosinophilic myocarditis. More extensive studies are urgently required to analyse the cardiac outcome under this treatment option.
Disclosures: None declared
