Case Study: Dobutamine-Induced Eosinophilic Myocarditis in Cardiogenic Shock
Overview
A 55-year-old man with dilated non-ischemic cardiomyopathy developed eosinophilic myocarditis (EM) triggered by dobutamine during treatment for cardiogenic shock. Discontinuation of dobutamine and initiation of corticosteroids led to improved ventricular function and hemodynamics, highlighting the importance of recognizing drug-induced EM.
Background
Eosinophilic myocarditis is a rare inflammatory cardiac condition often caused by hypersensitivity reactions to drugs. It can present with rapid clinical deterioration, especially in patients receiving inotropic support. Dobutamine, a commonly used inotrope in cardiogenic shock, may rarely induce EM. Early diagnosis and management, including cessation of the offending agent and corticosteroid therapy, are critical for patient recovery.
Data Highlights
Parameter
Value
Notes
Weight
129.7 kg (286 lb)
BMI 39.1 kg/m2
Heart Rate
102 beats/min
Mild tachycardia
Respiratory Rate
24 breaths/min
Tachypnea
NT-proBNP
2,500 pg/mL
Elevated
Lactate
2.5 mmol/L
Elevated
Troponin I
0.05 ng/mL
Stable on serial measurements
Left Ventricular Ejection Fraction
15%–20%
Severely reduced
LV Thrombus
7 mm × 5 mm
Detected on echocardiogram
Dobutamine Dose
Up to 5 μg/kg/min
Inotropic support
Milrinone Dose
0.25–0.375 μg/kg/min
Added for inotropy
Key Findings
The patient with dilated NICM developed refractory cardiogenic shock despite dual inotropic therapy including dobutamine.
Left ventricular apical biopsy revealed eosinophilic infiltration consistent with eosinophilic myocarditis.
Dobutamine was identified as the likely trigger after excluding other causes.
Discontinuation of dobutamine and corticosteroid therapy led to improvement in ventricular function and hemodynamics.
Alternative inotropes such as milrinone or epinephrine may be preferred in similar clinical scenarios.
Peripheral eosinophilia was not initially present, underscoring the need for biopsy in diagnosis.
Clinical Implications
Clinicians should maintain a high index of suspicion for drug-induced eosinophilic myocarditis in patients with cardiogenic shock who deteriorate on dobutamine therapy. Early myocardial biopsy can aid diagnosis when clinical and laboratory findings are inconclusive. Prompt withdrawal of the offending agent and initiation of corticosteroids can improve outcomes. Consideration of alternative inotropes is advisable to avoid recurrence.
Conclusion
Dobutamine-induced eosinophilic myocarditis is a rare but serious complication in patients with cardiogenic shock. Recognition and management through drug cessation and corticosteroid therapy can lead to significant clinical improvement.
References
Case Study: The Adverse Effects of Inotropy—Eosinophilic Myocarditis Induced by Dobutamine
by Abdullah Aljudaibi, Kristi Dutta, Sahitya Allam, Jose-Alejandro Almario, Lo Tamburro, Lynn Dees, Erik Sorensen, Bartley P. Griffith, Gautam Ramani, Manjula Ananthram