ABC | Volume 110, Nº6, June 2018

Case Report Dinis et al. Eosinophilic miocarditis Arq Bras Cardiol. 2018; 110(6):597-599 1. Caforio A, Pankuweit S, Arbustini E, Basso C, Gimeno-Blanes J, Felix S, et al; European Society of Cardiology Working Group on Myocardial and Pericardial Diseases. Current state of knowledge on aetiology, diagnosis, management, and therapy of myocarditis: a position statement of the European Society of Cardiology Working Group on Myocardial and Pericardial Diseases. Eur Heart J. 2013;34(33):2636-48, 2648a-2648d. doi: 10.1093/eurheartj/eht210. 2. Rezaizadeh H, Sanches-Ross M, Kaluski E, KlapholzM, Haider B, Gerula C. Acute eosinophilic myocarditis: diagnosis and treatment. Acute Card Care. 2010;12(1):31-6. doi: 10.3109/17482940903578998. 3. Thambidorai SK, Korlakunta HL, Arouni AJ, Hunter WJ, Holmber MJ. Acute eosinophilic myocarditis mimicking myocardial infarction. Tex Heart Inst J 2009;36(4):355-7. PMID: 19693316. 4. Friedrich MG, Sechtem U, Schultz-Menger J, Holmvang G, Alakija P, Cooper LT, et al; International Consensus Group on Cardiovascular Magnetic Resonance inMyocarditis. Cardiovascular magnetic resonance in myocarditis: A JACCWhite paper. J AmColl Cardiol. 2009;53(17):1475-87. doi: 10.1016/j.jacc.2009.02.007. 5. Aggarwal H, Jain D, Kaverappa V, Jain P, Kumar A, Yadav S, et al. Idiopathic hypereosinophilic syndrome presenting as severe Loeffler’s endocarditis. Arq Bras Cardiol. 2013;100(4):e43-6. PMID: 23681213. 6. El-Menyar A, Zubaid M, Sulaiman K, AlMahmeed W, Singh R, Alsheikh-Ali AA, et al; Gulf Registry of Acute Coronary Events (Gulf RACE) Investigators. Atypical presentation of acute coronary syndrome: a significant independent predictor of in-hospital mortality. J Cardiol. 2011;57(2):165-71. doi: 10.1016/j.jjcc.2010.11.008. 7. ArimaM, Kanoh T. Eosinophilic myocarditis associated with dense deposits of eosinophilic cationic protein (ECP) in endomyocardiumwith high serum ECP. Heart. 1999;81(6):669-71. PMID: 10336931. 8. Butterfield JH, Kane GC, Weiler CR. Hypereosinophilic syndrome: endomyocardial biopsy versus echocardiography to diagnose cardiac involvement. Postgrad Med. 2017;129(5):517-23. doi: 10.1080 /00325481.2017 .1317215. 9. Baccouche H, Mahrholdt H, Meinhardt G, Merher R, Voehringer M, Hill S, et al. Diagnostic synergy of non-invasive cardiovascular magnetic resonance and invasive endomyocardial biopsy in troponin-positive patients without coronary artery disease. Eur Heart J. 2009;30(23):2869-79. doi: 10.1093/ eurheartj/ehp328. 10. Frustaci A, Russo M, Chimenti C. Randomized study on the efficacy of immunosuppressive therapy in patients with virus-negative inflammatory cardiomyopathy: the TIMIC study. Eur Heart J. 2009;30(16):1995-2002. doi: 10.1093/eurheartj/ehp249. References This is an open-access article distributed under the terms of the Creative Commons Attribution License fraction), 10 which was verified in this case. The question remains whether this improvement is due only to the corticosteroid or if it is associated with initiation of therapy for heart failure, in particular beta-blockers. The mechanism of action of corticosteroids in myocarditis is not fully understood, however it is thought that they interfere with eosinophilia; antagonize the development and maturation pathways; and promote the redistribution of peripheral blood eosinophils. 10 During follow-up, all patients should be submitted to clinical evaluations with electrocardiogram and echocardiogram. If clinical or imaging worsening occurs, hospital readmission and repeat cardiac magnetic resonance and / or endomyocardial biopsy may be required. 1,9 Conclusion Eosinophilic myocarditis is a rare, undiagnosed condition that can be fatal if not detected and treated in time. Author contributions Acquisition of data and Writing of the manuscript: Dinis P, Puga L; Critical revision of the manuscript for intellectual content: Dinis P, Teixeira R, Lourenço C, Cachulo MC, Gonçalves L. Potential Conflict of Interest No potential conflict of interest relevant to this article was reported. Sources of Funding There were no external funding sources for this study. Study Association This study is not associatedwith any thesis or dissertationwork. 599