Churg–Strauss Syndrome with Eosinophilic Myocarditis

We present the case of a 28-year-old man who presented with chest pain and elevated cardiac biomarkers, with no evidence of acute ischaemia. He had a pronounced eosinophilia, abnormal echocardiographic, cardiac MRI and CT findings. He underwent transbronchial biopsy of carinal lymph nodes and of lung parenchyma. Endomyocardial biopsy yielded an eosinophilic infiltrate. He was treated with high dose glucocorticoids and made a rapid recovery. Testing for FIP1L1-PDGFRA and other BCR-ABL1 mutations was negative. Ultimately, he was diagnosed with eosinophilic granulomatosis with polyangiitis, also known as Churg-Strauss syndrome.

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Eosinophilic myocarditis as a first presentation of eosinophilic granulomatosis with polyangiitis (Churg-Strauss syndrome)

Bluett¹,

McDonnell²,

O’Dowling

et al. 2017

“…Cardiac involvement in allergic granulomatosis is relatively well described and is considered to be a poor prognostic feature 4. However, arrhythmia as a presenting feature is relatively rare 5.…”

Section: Discussionmentioning

confidence: 99%

Missing the beat: arrhythmia as a presenting feature of eosinophilic granulomatosis with polyangiitis

Sharpley

2014

Palpitations are a common presenting symptom in patients attending the emergency department; however, eosinophilic infiltration of the myocardium is rarely the cause. This case describes a 77-year-old woman who presents with sudden onset palpitations and is later diagnosed with eosinophilic granulomatosis with polyangiitis (previously known as Churg-Strauss syndrome). Cardiac involvement does occur in 50% of cases but heart failure, myocarditis, pericarditis, constrictive pericarditis and myocardial infarction are much more commonly recognised complications. Arrhythmia is less well described. In this report, we propose eosinophilic inflammation as the precipitant for an aberrant conduction pathway.

“…Cardiovascular disease occurs in about 50% of patients with CSS and the clinical spectrum of cardiac involvement ranges from patients being asymptomatic, having acute and/or constrictive pericarditis, restrictive or dilated cardiomyopathy, intracavity thrombi, abnormalities in ECGs and sudden death 9. Eosinophilic infiltration of the myocardium and coronary vessel vasculitis are the most common lesions leading to coronary disease and congestive cardiac failure 8…”

Section: Discussionmentioning

confidence: 99%

“…Echocardiography may be normal or may show impairment of contractility, thickening of the ventricular wall and the presence of intracardiac thrombi or pericardial effusion. A coronary angiogram is more accurate than MR angiogram for detection of vasculitis; however, an angiogram can have false-negative results 9. Cardiac MRI may confirm myocardial necrosis, inflammation or thrombosis 4.…”

Section: Discussionmentioning

confidence: 99%

Is this an exacerbation of asthma? A cautionary tale

Sidhu¹,

Nanda

Abbas

2013

SUMMARYAsthma exacerbations are a fairly common presentation to emergency departments. However, a careful history, clinical examination and interpretation of investigations may uncover a more serious pathology. We present an interesting case of a 44-year-old man with symptoms suggestive of an asthma exacerbation, who was found to have Churg-Strauss vasculitis/eosinophilic granulomatosis with polyangitis. He had clinical features of a vasculitis, ECG changes and a troponin T level of 7562 ng/L. Renal biopsy confirmed Churg-Strauss vasculitis. Cardiac involvement in Churg-Strauss Syndrome (CSS) is one of the leading causes of mortality. We describe the successful diagnosis and management of a patient with CSS.