Eosinophilic Myocarditis in Long Term Use of Antipsychotics: Case Series and Review of the Literature

Long term use of antipsychotics, is encountered in many psychiatric disorders, especially in schizophrenia. Eosinophilic myocarditis is a rare form of myocarditis characterized by myocardial inflamation composed of mostly eosinophils. It is known that it may develop at a rate of 0.2-3 % in long term therapies, especially with clozapine use. Standart treatment can not be established because of rarity of disease and difficulties in the determination of the etiology. In this article, three cases, who have been receiving long term drug treatment for schizoaffective disorder and faced sudden death, were presented. Their autopsies were performed in our institution. When myocardial sections were examinated with light microscope, common findings with three cases were, myocyte damage accompanied with patchy distribution of perivascular and interstitial inflamatory infiltrate rich in eosinophils. When the light microscopic findings evaluated with detailed medical history, autopsy findings and toxicological analysis results, we considered these entities may have developed as a result of hypersensitivity reaction due to long term antipsychotic drug use. Eosinophilic myocarditis is encountered as a rare clinical entity and probably it is a subtype of myocarditis that is overlooked. Failure in the clinical diagnosis and delay in treatment may lead to irreversible myocardial damage and death. Endomyocardial biopsy is still the gold standard in the diagnosis of eosinophilic myocarditis. Here, we present these cases since the drug use is the most frequently accused cause, it is rarely seen in acute deaths and the diagnosis can be reached by histopathological examination.