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.