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Fatal Acute Necrotizing Eosinophilic Myocarditis during Peripartum: Case Report

Santa Carbonara, Marco Matteo Ciccone, Pietro Scicchitano, Massimo Colonna, Eloisa Maselli, Ilaria Dentamaro, Andrea Marzullo, Gabriella Ricci, Biagio Solarino

Peripartum heart disease is a rare group of disorders developing during the last trimester of pregnancy through the first 6 months of postpartum. The etiology and pathogenesis of Peripartum Cardiomyopathy (PPCM) is unknown but viral and autoimmune causes may contribute. Myocardial involvement includes myocarditis, coronary artery dissection and peripartum cardiomyopathy. Risk factors for PPCM include advanced maternal age, multiparity, African race, twin birth, gestational hypertension and long-term tocolysis. We report the case of a 29-year-old pregnant, that after the delivery at the 37th week of gestational age, complained weakness and abdominal pain. The young woman showed since the third day postpartum worsening chest pain associated with malaise, non-specific symptoms, and increase in inflammatory markers without peripheral eosinophil increase. Physicians, suspecting a gastric disorder, treated her with antiacids and proton pump inhibitors, and advised gastroenterology consulting. The patient entered in emergency room in critical conditions, with severe left ventricular systolic dysfunction and an ejection fraction of 25%. She died 23 day after delivery.