Biventricular assist device placement and immunosuppression as therapy for necrotizing eosinophilic myocarditis

Background: A previously healthy 47-year-old woman presented reporting nausea, anorexia and light-headedness of 2 weeks' duration, and three episodes of syncope. She also had pleuritic chest pain and rapidly declining cardiac function. The only reported medical history was urinary tract infection and an ankle fracture sustained 5 months before presentation. She was receiving no medication other than estrogen patches for menopause and did not smoke or use illicit drugs. Investigations: Electrocardiography, chest radiography, echocardiography, measurement of creatinine phosphokinase and troponin T, coronary angiography and endomyocardial biopsy. Diagnosis: Necrotizing eosinophilic myocarditis. Management: Biventricular assist device implantation, methylprednisolone, prednisolone and mycophenolate mofetil.