Objective
Hypereosinophilia, marked increase of eosinophil count up to 1.5×103/μL; may be complicated with tissue injuries due to vasculitis or thrombosis. Since eosinophils have granules with highly potent proinflammtory and prothrombotic content they may promote inflammatory and thrombotic process de novo. According to the tissue clinical sign and findings may vary. We presented a young adult who developed infiltrative myocarditis during the follow up for hypereosinophilic pneumonia with migratory infiltration on lung tissue.
Method
Patient has been treated with classical pneumonia for 1 week at an outer pulmonary service. When he presented to service of Pulmonary and Respiratory Disease a migratory pneumonic infiltration with progression on chest x-ray was detected. First lesion which was detected as left sided apical lesion one week before progressed and recurred as right sided subpleural foci on control X-ray (Figure). Eosinophil count was 8.47×103/μL (57%) on complete blood count. High resolution computed tomography revealed 1 cm nodule on inferior of right superior lobule, several foci of ground glass images on paramediastinal region of right superior lobule.and bronchiectasia on bilateral apical segments of superior lobules. Patient was consultated with cardiology service for the probable complications of hypereosinophilia. Transthoracic echocardiography revealed a hyperechogen infiltrative density with 1×2 cm diameters on the basal and mid segments of posterior wall of left ventricle (Figure). Cardiac troponin level was slightly increased as 0.320 ng/ml. ECG was remarkable with minimal T wave inversion on inferior leads. Patient was diagnosed as myocarditis and was initiated intravenous steroid therapy to prevent progression and worsening of myocarditis.
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