digoxin and Eosinophilia

A case of systemic allergic-type vasculitis after the administration of quinidine and digoxin is described. The renal biopsy findings are unique in that they describe an arteritis with eosinophilic infiltration and non-caseating granulomata. We believe quinidine is the antigen that was responsible for the reported findings.

Topics: Acute Kidney Injury; Digoxin; Drug Therapy, Combination; Eosinophilia; Granuloma; Humans; Male; Middle Aged; Quinidine; Vasculitis, Leukocytoclastic, Cutaneous

Topics: Digoxin; Eosinophilia; Female; Heart Failure; Humans; Middle Aged; Prednisone; Syndrome

We have studied a patient with hypereosinophilic syndrome (HES) who initially presented with recurrent asthmatic attacks followed by progressive dyspnea. Chronic obstructive lung disease was suspected at first although involvement of cardiac and other organ systems and marked eosinophilia eventually led to the diagnosis. Thereafter a diffuse interstitial pattern gradually developed on the chest radiograph which persisted despite vigorous treatment for cardiac failure. This was due to infiltration and cuffing of the small pulmonary arteries by eosinophils. The bronchi showed changes consistent with asthma. Review of the literature indicates that this type of vascular change is common in HES but involves predominantly organs other than the lung. Similar pulmonary arterial changes have been produced experimentally in the calf by prolonged intravenous infusion of antibiotics, indicating that this may be a hypersensitivity reaction to a blood-borne material entering the pulmonary circulation.

Topics: Aged; Autopsy; Bronchodilator Agents; Digoxin; Eosinophilia; Female; Furosemide; Heart Failure; Humans; Intracranial Embolism and Thrombosis; Lung Diseases, Obstructive; Prednisone; Pulmonary Artery; Syndrome

Five patients were seen at the Mayo Clinic over an 8-year period with the following complex of clinical and morphologic features; striking eosinophilia, cardiomyopathy, hepatosplenomegaly, and either a rapidly fatal or a prolonged, debilitating illness. In recent years, controversy has raged over the precise designation of this syndrome, with proposals ranging from eosinophilic leukemia to hypereosinophilic syndromes. To focus on the major target organ of the disease, we have favored the term endomyocardiopathy with eosinophilia. Experience with these five patients showed that (1) eosinophilia can persist for many years before symptoms appear; (2) progressive restrictive cardiac disease was the major cause of death and debility; (3) osmiophilic cytoplasmic inclusions are present in eosinophils of these patients and also in cells from other patients with marked eosinophilia; and (4) echocardiography may prove to be a useful noninvasive tool to diagnose and follow the progress of cardiac involvement. Although none of these patients was thought to have leukemia, intensive therapy with steroids or cytotoxic agents, or both, is considered necessary to control the progression of the disease.

Topics: Adolescent; Adult; Busulfan; Cardiomyopathies; Cytoplasmic Granules; Digoxin; Diphenhydramine; Eosinophilia; Eosinophils; Female; Furosemide; Hepatomegaly; Humans; Hydroxyurea; Male; Middle Aged; Prednisone; Splenomegaly; Syndrome

Topics: Asthma; Biomedical Research; Blood Pressure; Blood Pressure Determination; Bronchitis; Cardiac Catheterization; Digitalis; Digoxin; Electrocardiography; Eosinophilia; Humans; Lung Diseases; Pharmacology; Pulmonary Artery; Pulmonary Emphysema