Cardiac magnetic resonance imaging: a non-invasive tool for the diagnosis of eosinophilic myocarditis.

Acute eosinophilic myocarditis is a rare disorder characterized by diffuse or focal myocardial inflammation with eosinophilic infiltration. Early treatment can reduce its mortality. Here we report the case of a 64-year-old-man with a previous history of asthma and chronic eosinophilic pneumonia who was admitted to the cardiology department complaining of atypical chest pain and flu-like illness for two days. The ECG showed negative T waves in leads V4-V6. Ultrasensitive troponin T was 1048 ng/l (normal range <14 ng/l) with C-reactive protein 2.1 mg/dl (normal 0--0.5 mg/dl) and increased eosinophil count of 21%. The echocardiogram demonstrated slightly increased left ventricular apical wall thickness (Figure 1A, arrow) and apical hypokinesia with borderline ejection fraction. Given the suspicion of eosinophilic vasculitis, intensive treatment with corticosteroids and immunosuppressive agents was begun. A new echocardiogram nine days after admission showed a slight decrease in the thickness of the apical segment with normal ejection fraction (Figure1B, arrow). Cardiac