INTRODUCTION
The HES are rare and have an unknown prevalence. It is more common in
men compared to women and rates increase with age to peak in the range
of 65-74 years2. Only some patients with persistent
eosinophilia develop organ dysfunction that characterizes HES.
Essentially, all organs may be susceptible to the effects of sustained
eosinophilia and the heart is no exception. Cardiac involvement can
cause significant morbidity and mortality3.
Eosinophilic myocarditis is a rare presentation of HES but poses a
diagnostic challenge since initial investigations are non-specific and
definitive diagnosis requires either endomyocardial biopsy or cardiac
magnetic imaging which may not be readily available. The diagnosis may
be further delayed where other sinister etiologies of chest pain need to
be ruled out such as Acute Coronary Syndrome requiring cardiac
catheterization. However, in patients with high clinical suspicion for
acute myocarditis and confirmed peripheral eosinophilia, timely
diagnosis and treatment is imperative to avoid the catastrophic
consequence of irreversible fibrotic changes to the cardiac tissue. We
present a case of eosinophilic myocarditis as the initial presentation
of HES and discuss the pathophysiology, diagnosis and management of such
cases.