Dobutamine-Induced Eosinophilic Myocarditis in Heart Failure Patient Requiring Urgent Left Ventricular Assist Device Implantation (LVAD): A Case Report


Durre Shahwar

Introduction

Dobutamine is a relatively unrecognised cause of eosinophilic myocarditis (ESM) which can be an especially significant cause for acute decompensation in heart-failure patients who already have a poor cardiac reserve.

Case Anecdote

76 year old woman with end-stage dilated cardiomyopathy was placed on dobutamine to improve renal function and mild hypoperfusion symptoms. Deemed dobutamine dependent, she suffered torsades de pointes cardiac arrest, requiring defibrillation and urgent LVAD. Her ventricular core biopsy showed myocytolysis with eosinophilic infiltrate congruent with ESM, which potentially may have accelerated her clinical deterioration. 

Discussion

Although the incidence of ESM remains low, it can be found in 23% of explanted hearts given how frequently inotropic support is used in heart failure (Johnson, 2004), occurring more commonly with dobutamine support (Yoshizawa, 2013). In fact, Takkenburg (2004) reported dobutamine was implicated in 12 out of 14 cases of ESM (86%). Moreover, Johnson (2004), found that ESM patients were not only more likely to be on inotropic support but also progressed to LVAD implantation. 

Conclusion

Prolonged continuous intravenous dobutamine administration can cause eosinophilic myocarditis and it should be considered a differential for acute cardiac decompensation in inotropic dependent heart failure.    

References 

1. Johnson MR. Eosnophilic myocarditis in the explanted hearts of cardiac transplant recipients: interesting pathologic finding or pathophysiologic entity of clinical significance? Crit Care Med 2004; 32: 888-90. 
2. Takkenberg JJ, Czer LS, Fishbein MC et al. Eosinophilic myocarditis in patients awaiting heart transplantation. Crit Care Med 2004; 32: 714-721. 
3. Yoshizawa S, Kato TS, Mancini D, et al. Hypersensitivity myocarditis and outcome after heart transplantation. The Journal of Heart and Lung Transplantation 2013; 32: 553-559.