Fever and Hypereosinophilia

A 70-year-old man presented with progressive decline in his functional status, cachexia and resting shortness of breath. He had long-standing history of heart failure due to non-ischemic dilated cardiomyopathy with an ejection fraction of 15% treated with cardiac resynchronization and guideline-directed medical therapy. He had history of ventricular tachycardia, non obstructive coronary artery disease, chronic kidney disease stage III, atrial fibrillation and left atrial appendage closure. On admission, his blood pressure was 74/40 mmHg, heart rate of 70 bpm and with adequate oxygen saturation. Physical examination revealed a cachectic man with anasarca, distended jugular veins and cold extremities compatible with hypoperfusion. He was admitted to the cardiac intensive care unit and inotrope support with dobutamine and IV diuretics were initiated. He was inotrope dependent and was discharged home with dobutamine infusion at 5mcg/kg/min. A week later he presents to the emergency room with worsening heart failure and ventricular tachycardia. This time, his white cell count was elevated and eosinophilia was noted. During this admission, he developed fevers, elevated liver enzymes and creatinine. A thorough infectious workup was done and revealed no bacterial, viral or parasitic infection.

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