CTICasesEosinophilic Myocarditis (Presumptive Churg-Strauss Syndrome / EGPA)
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Imaging findings
Cardiac CT and MRI revealed dilated cardiomyopathy with reduced ejection fraction and a distinctive pattern of patchy midwall to subendocardial and some transmural delayed myocardial enhancement, atypical for classic Loeffler endocarditis. Chest CT showed confluent upper lobe predominant parenchymal consolidation. Peripheral eosinophilia was extremely high. Transbronchial lung biopsy showed eosinophilic myocarditis. Post-steroid treatment, lung changes improved, and cardiac function partially recovered.
Key takeaways
Eosinophilic myocarditis can cause dilated cardiomyopathy and is a severe manifestation of eosinophilic-driven diseases. Churg-Strauss Syndrome (Eosinophilic Granulomatosis with Polyangiitis - EGPA) should be considered, even without confirmed vasculitis on biopsy, if clinical criteria (asthma, eosinophilia, pulmonary infiltrates, sinusitis/rhinitis) are met. Cardiac involvement in EGPA can present with diverse patterns of myocardial enhancement. Response to corticosteroids is a key diagnostic and therapeutic indicator.
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