Hypersensitivity Myocarditis Associated with Drug Allergy

 

Features:

(1) The patient may be:

(1a) asymptomatic

(1b) suffer sudden death

(1c) develop a cardiac arrhythmia

(1d) deterioration in cardiac function

(2) The presence of peripheral eosinophilia.

(3) A cardiac biopsy shows a perivascular infiltrate of eosinophils, lymphocytes and histiocytes in the myocardium.

(4) The onset is associated with exposure to an implicated drug.

(5) There is resolution on discontinuation of the drug.

(6) Exclusion of alternative explanations.

 

Drugs implicated in hypersensitivity myocarditis include:

(1) amphotericin B

(2) azithromycin

(3) carbamazepine

(4) cephalosporins

(5) chlorthalidone

(6) clozapine

(7) dapsone

(8) dobutamine

(9) ephedra

(10) hydrochlorthiazide

(11) imipramine

(12) isoniazid

(13) mesalamine

(14) methyldopa

(15) penicillin

(16) phenytoin

(17) streptomycin

(18) sulfonamides

(19) tetanus toxoid