Successful Management of Oxacillin-Induced Eosinophilic Myocarditis and Review of the Literature.

BACKGROUND

Numerous medications have been implicated in precipitating eosinophilic myocarditis (EM), particularly antipsychotics and cytotoxic drugs. Antibiotic-induced EM, scarcely reported in the literature, carries a high mortality rate.

CASE SUMMARY: A 56-year-old man with a history of atypical hemolytic uremic syndrome presented with acute heart failure after completing oxacillin treatment for methicillin-susceptible Staphylococcus aureus bacteremia. Diagnosis of antibiotic-induced EM was established with endomyocardial biopsy, and the patient made full recovery with high-dose steroid treatment.

REVIEW SUMMARY: Prompt diagnosis and early steroid treatment is essential in reducing mortality in patients with antibiotic-induced EM. Multidisciplinary discussion is vital, and development of clinical scoring criteria to identify high-risk patients may assist clinicians in pursuing early endomyocardial biopsy to expedite diagnosis.

TAKE-HOME MESSAGE: Antibiotic-induced EM is exceedingly rare but should be suspected when acute heart failure is associated with systemic inflammatory symptoms.