Improvement of eosinophilic heart disease after steroid therapy: successful demonstration by endomyocardial biopsied specimens

A 62-year-old man with acute eosinophilic endomyocarditis developed congestive heart failure. The biopsy specimens revealed degranulated eosinophils and eosinophil cationic protein (ECP) in the endocardium, and in activated eosinophils and the myocardial interstitium. On electronmicroscopy, a characteristic cardiac myocytolytic change showing disruption at the intercellular junctional site was observed. After steroid treatment, clinical symptoms, systolic dysfunction and laboratory data dramatically improved. In the subsequent biopsy specimens, eosinophilic infiltration and ECP disappeared. Steroid therapy provided a beneficial effect in preventing the progression of cardiac damage. This effect was clearly documented by histochemical studies of the serial endomyocardial biopsy samples. we describe a patient with eosinophilic endomyocardial disease who showed striking improvement in clinicopathological findings after steroid treatment. Ultrastructural and immunohistochemical investigations of serial myocardial specimens confirmed the effects of steroid therapy.