Diagnosis of Exclusion: A Case Report of Probable Glatiramer Acetate-Induced Eosinophilic Myocarditis
Importance. Medication-induced eosinophilia is an acknowledged, often self-limiting occurrence. Glatiramer acetate, a biologic injection used in the management of relapsing-remitting multiple sclerosis, is widely regarded as a safe and effective medication and lists eosinophilia as an infrequent sid...
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| Format: | Article |
| Language: | English |
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Wiley
2014-01-01
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| Series: | Case Reports in Neurological Medicine |
| Online Access: | http://dx.doi.org/10.1155/2014/786342 |
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| author | Christopher J. Michaud Heather M. Bockheim Muhammad Nabeel Timothy E. Daum |
| author_facet | Christopher J. Michaud Heather M. Bockheim Muhammad Nabeel Timothy E. Daum |
| author_sort | Christopher J. Michaud |
| collection | DOAJ |
| description | Importance. Medication-induced eosinophilia is an acknowledged, often self-limiting occurrence. Glatiramer acetate, a biologic injection used in the management of relapsing-remitting multiple sclerosis, is widely regarded as a safe and effective medication and lists eosinophilia as an infrequent side effect in its package insert. Contrary to reports of transient, benign drug-induced eosinophilia, we describe a case of probable glatiramer acetate-induced eosinophilia that ultimately culminated in respiratory distress, shock, and eosinophilic myocarditis. Observations. A 59-year-old female was admitted to the hospital after routine outpatient labs revealed leukocytosis (43,000 cells/mm3) with pronounced hypereosinophilia (63%). This patient had been using glatiramer acetate without complication for over 10 years prior to admission. Leukocytosis and hypereosinophilia persisted as a myriad of diagnostic evaluations returned negative, ultimately leading to respiratory depression, shock, and myocarditis. Glatiramer acetate was held for the first time on day 6 of the hospital stay with subsequent resolution of leukocytosis, hypereosinophilia, respiratory distress, and shock.
Conclusions and Relevance. Glatiramer acetate was probably the cause of this observed hypereosinophilia and the resulting complications. Reports of glatiramer-induced eosinophilia are rare, and few case reports regarding medication-induced hypereosinophilia describe the severe systemic manifestations seen in this patient. |
| format | Article |
| id | doaj-art-ea8eabe9f692402e80fa3ba33192b20c |
| institution | Kabale University |
| issn | 2090-6668 2090-6676 |
| language | English |
| publishDate | 2014-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Case Reports in Neurological Medicine |
| spelling | doaj-art-ea8eabe9f692402e80fa3ba33192b20c2025-02-03T00:59:11ZengWileyCase Reports in Neurological Medicine2090-66682090-66762014-01-01201410.1155/2014/786342786342Diagnosis of Exclusion: A Case Report of Probable Glatiramer Acetate-Induced Eosinophilic MyocarditisChristopher J. Michaud0Heather M. Bockheim1Muhammad Nabeel2Timothy E. Daum3Department of Pharmacy, Spectrum Health, 100 Michigan Street NE, MC 001, Grand Rapids, MI 49503, USADepartment of Pharmacy, Spectrum Health, 100 Michigan Street NE, MC 001, Grand Rapids, MI 49503, USAInternal Medicine, Spectrum Health, Grand Rapids, MI 49503, USAPulmonary Critical Care, Spectrum Health Medical Group, Grand Rapids, MI 49503, USAImportance. Medication-induced eosinophilia is an acknowledged, often self-limiting occurrence. Glatiramer acetate, a biologic injection used in the management of relapsing-remitting multiple sclerosis, is widely regarded as a safe and effective medication and lists eosinophilia as an infrequent side effect in its package insert. Contrary to reports of transient, benign drug-induced eosinophilia, we describe a case of probable glatiramer acetate-induced eosinophilia that ultimately culminated in respiratory distress, shock, and eosinophilic myocarditis. Observations. A 59-year-old female was admitted to the hospital after routine outpatient labs revealed leukocytosis (43,000 cells/mm3) with pronounced hypereosinophilia (63%). This patient had been using glatiramer acetate without complication for over 10 years prior to admission. Leukocytosis and hypereosinophilia persisted as a myriad of diagnostic evaluations returned negative, ultimately leading to respiratory depression, shock, and myocarditis. Glatiramer acetate was held for the first time on day 6 of the hospital stay with subsequent resolution of leukocytosis, hypereosinophilia, respiratory distress, and shock. Conclusions and Relevance. Glatiramer acetate was probably the cause of this observed hypereosinophilia and the resulting complications. Reports of glatiramer-induced eosinophilia are rare, and few case reports regarding medication-induced hypereosinophilia describe the severe systemic manifestations seen in this patient.http://dx.doi.org/10.1155/2014/786342 |
| spellingShingle | Christopher J. Michaud Heather M. Bockheim Muhammad Nabeel Timothy E. Daum Diagnosis of Exclusion: A Case Report of Probable Glatiramer Acetate-Induced Eosinophilic Myocarditis Case Reports in Neurological Medicine |
| title | Diagnosis of Exclusion: A Case Report of Probable Glatiramer Acetate-Induced Eosinophilic Myocarditis |
| title_full | Diagnosis of Exclusion: A Case Report of Probable Glatiramer Acetate-Induced Eosinophilic Myocarditis |
| title_fullStr | Diagnosis of Exclusion: A Case Report of Probable Glatiramer Acetate-Induced Eosinophilic Myocarditis |
| title_full_unstemmed | Diagnosis of Exclusion: A Case Report of Probable Glatiramer Acetate-Induced Eosinophilic Myocarditis |
| title_short | Diagnosis of Exclusion: A Case Report of Probable Glatiramer Acetate-Induced Eosinophilic Myocarditis |
| title_sort | diagnosis of exclusion a case report of probable glatiramer acetate induced eosinophilic myocarditis |
| url | http://dx.doi.org/10.1155/2014/786342 |
| work_keys_str_mv | AT christopherjmichaud diagnosisofexclusionacasereportofprobableglatirameracetateinducedeosinophilicmyocarditis AT heathermbockheim diagnosisofexclusionacasereportofprobableglatirameracetateinducedeosinophilicmyocarditis AT muhammadnabeel diagnosisofexclusionacasereportofprobableglatirameracetateinducedeosinophilicmyocarditis AT timothyedaum diagnosisofexclusionacasereportofprobableglatirameracetateinducedeosinophilicmyocarditis |