Eosinophilic myocarditis: a diagnostic challenge and treatment dilemma—a case report

Abstract Background Eosinophilic myocarditis, a rare and potentially life-threatening condition, can resemble acute coronary syndrome (ACS) and presents diagnostic difficulties. Case report We describe the case of a 32-year-old man initially admitted with ACS-like symptoms, but ultimately diagnosed with eosinophilic myocarditis. The patient presented with intense retrosternal chest pain, significant eosinophilia, and elevated cardiac enzymes. Despite clinical indications suggesting myocardial involvement, an endomyocardial biopsy was not performed due to the patient’s reluctance. Non-invasive imaging and clinical findings led to the presumptive diagnosis of eosinophilic myocarditis. The patient was treated with high-dose corticosteroids and immunosuppressive therapy, resulting in clinical improvement. Discussion Our report highlights the importance of considering eosinophilic myocarditis and hypereosinophilic syndrome when evaluating patients with chest pain and hypereosinophilia. It emphasizes the subtleties of diagnosis and the critical need for early identification and appropriate treatment to improve prognosis in cases of eosinophilic myocarditis. This case underscores the diverse clinical manifestations of myocarditis and the essential need for a comprehensive diagnostic approach in the presence of chest pain and hypereosinophilia.