ArticleEuropean journal of case reports in internal medicine2026
Golimumab-Associated Myocarditis with Progressive Eosinophilia after Route Switch in Rheumatoid Arthritis.
Article in European journal of case reports in internal medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Introduction: Tumour necrosis factor-alpha (TNF-α) inhibitors are cornerstone therapies in rheumatoid arthritis (RA) and generally reduce cardiovascular events. Drug-induced myocarditis associated with TNF-α inhibitors is not well-established in pharmacovigilance databases. Case description: A 51-year-old male with seropositive RA receiving intravenous golimumab presented with acute chest pain, dyspnoea, and left arm numbness without viral prodrome. He had been switched from subcutaneous to intravenous golimumab 6 months prior, producing a 14-fold increase in peak serum concentration. High-sensitivity troponin I peaked at 32,419 ng/l with mildly reduced left ventricular ejection fraction (45-49%) and global hypokinesis. Coronary angiography revealed non-obstructive arteries. Comprehensive viral serology was negative for acute infection. Inflammatory markers were normal. Progressive eosinophilia developed during hospitalization (0.12 → 0.54 ×10 Conclusion: This case meets criteria for clinically suspected myocarditis per the 2024 American College of Cardiology Expert Consensus Decision Pathway. The absence of viral prodrome, negative viral serology, progressive eosinophilia, normal inflammatory markers, and complete functional recovery paralleling drug elimination support drug-induced hypersensitivity myocarditis. Causality assessment yields "probable" by both the World Health Organization - Uppsala Monitoring Centre system and the Naranjo algorithm (score 6 to 8). This case contributes to the limited literature on TNF-α inhibitor cardiotoxicity and emphasizes the need for continued pharmacovigilance. LEARNING POINTS: Tumour necrosis factor-alpha inhibitor-associated myocarditis is exceptionally rare; clinicians should consider this diagnosis in patients presenting with acute troponinemia and non-obstructive coronary arteries while receiving biologic therapy.Switching from subcutaneous to intravenous golimumab produces an approximately 14-fold increase in peak serum concentration (C
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