Case Report: Area of Focus of Myocardial Infarction With Non-obstructive Coronary Arteries in Eosinophilic Granulomatosis With Polyangiitis

Cui, Xiaoxian; Yang, Peng; Li, Jun; Dong, Yugang; Wu, Zexuan; Chen, Yili

doi:10.3389/fcvm.2021.731897

Cited by 1 publication

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“…Notably, in our case, multiple foci on the initial LGE were resolved following the corticosteroid treatment. Similar foci have been reported in some cases of EGPA-associated EM, and are presumed to be specific to vasculitis, which can be an indicator for EGPA-associated EM ( 35 , 43 , 55 ). Further studies on the relationship between foci on LGE and their respective pathologies are warranted.…”

Section: Discussionsupporting

confidence: 77%

The Diagnostic Challenge of Eosinophilic Granulomatosis With Polyangiitis Presenting as Acute Eosinophilic Myocarditis: Case Report and Literature Review

Yamamoto

HASHIMOTO

Ikeda

et al. 2022

Front. Cardiovasc. Med.

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Eosinophilic granulomatosis with polyangiitis (EGPA) is a systemic vasculitis involving small-to-medium-sized vessels characterized by asthma, vasculitis, and peripheral eosinophilia. EGPA-associated eosinophilic myocarditis (EM) occurs rarely, yet can be fatal if left untreated. Moreover, the accurate diagnosis of EGPA-associated EM without vasculitis is exceptionally difficult because of the overlapping features with EM of other causes. We report a case of probable EGPA with subclinical neurological involvement that presented with acute EM. The constellation of peripheral eosinophilia, left ventricular dysfunction, and normal epicardial coronary arteries raised suspicion of acute EM, which was confirmed by cardiac magnetic resonance (CMR) investigation and endomyocardial biopsy (EMB). Prompt systemic administration of corticosteroids completely restored and normalized myocardial structure and function. Although the patient's history suggested the presumed hypersensitivity myocarditis, EMB revealed EM without vasculitis, not hypersensitivity, leading to a tentative diagnosis of idiopathic hypereosinophilic syndrome. Interestingly, the characteristic findings of vasculitis on CMR imaging strongly suggested EGPA-associated EM. Although the patient had no clinical neurological manifestations, a nerve conduction study confirmed mononeuritis multiplex, leading to the final diagnosis of probable EGPA. Therefore, this case highlights the diagnostic challenge associated with EGPA and the diagnostic synergy of CMR and EMB for an exploratory diagnosis of EGPA-associated EM.

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Section: Discussionsupporting

confidence: 77%