ArticleJACC. Case reports2026
Fulminant Eosinophilic Myocarditis After Sequential Biologic Therapy in Ulcerative Colitis.
Article in JACC. Case reports, 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
backgroundEosinophilic myocarditis has heterogeneous presentations and may cause fulminant cardiogenic shock. CASE SUMMARY: A 35-year-old man with ulcerative colitis and eosinophilia developed cardiogenic shock after sequential biologic therapy (most recently vedolizumab) and corticosteroid withdrawal. He rapidly deteriorated with severe biventricular dysfunction (left ventricular ejection fraction 10%) and hypereosinophilia (eosinophil count 2,154/μL). Coronary angiography showed no obstructive disease, and cardiac magnetic resonance suggested diffuse myocardial involvement. Endomyocardial biopsy confirmed eosinophilic myocarditis. He required veno-arterial extracorporeal membrane oxygenation and high-dose intravenous methylprednisolone. Recurrent eosinophilia during tapering prompted use of mepolizumab, followed by recovery of left ventricular function. DISCUSSION: Biologic exposure with corticosteroid withdrawal was temporally associated with systemic eosinophilic activation, and histologic confirmation by biopsy enabled escalation to targeted therapy. TAKE-HOME MESSAGES: In patients with inflammatory bowel disease receiving biologics, hypereosinophilia with acute heart failure should prompt evaluation for eosinophilic myocarditis. Early biopsy may enable timely escalation to targeted immunomodulatory therapy.
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