Drug related myocarditis

Abstract

Morphologic changes in drug related hypersensitivity myocarditis were characterized. Clinical histories and microscopic findings in 24 patients with validated drug hypersensitivity and myocarditis were reviewed. Myocarditis in these patients was characterized by a patchy interstitial inflammatory infiltrate rich in eosinophils, focal myocytolysis, prominent perivascular infiltrates, an absence of myocardial fibrosis and the uniform features of the myocarditis in each patient. Of the 24 patients 20 died suddenly and unexpectedly. The presence of signs and symptoms of hypersensitivity (skin rash, fever, eosinophilia and malaise) and nonspecific cardiac findings (electrocardiographic changes, tachycardia or serum enzyme elevations) indicated hypersensitivity myocarditis in these patients. Since early diagnosis is vital in hypersensitivity myocarditis, the presence of nonspecific cardiac findings in a patient receiving any drug associated with hypersensitivity should alert the clinician to the possibility of drug related myocarditis.