Acute coronary vasospasm in a patient with eosinophilic granulomatosis with polyangiitis following NSAID administration

Abstract

Eosinophilic with polyangiitis (EGPA, formerly known as Churg-Strauss syndrome) is a rare systemic disease characterized by a small-vessel necrotizing vasculitis. Cardiac manifestations are broad-ranging and are associated with a poor prognosis. Coronary vasospasm is uncommon.Here, we report a case of an acute coronary vasospasm in a patient with EGPA after corticosteroids withdrawal and nonsteroidal antiinflammatory drug (NSAID) introduction. This patient was initially misdiagnosed as bradykinin-mediated angioedema. A 30-year-old man presented with recurrence of abdominal pain and acute dyspnea. NSAID administration for pain during a flare was followed by coronary vasospasms leading to cardiac arrest. Corticosteroid treatment was recently interrupted by the patient.This case reports a rare cardiac complication of EGPA. NSAID might contribute to coronary vasospasm by eosinophilic degranulation in EGPA. Moreover, corticosteroid compliance must be emphasized among patients who display EGPA with high cardiac risk to prevent fatal issues.

Successful Treatment with Mepolizumab for Coronary Spastic Angina Associated with Eosinophilic Granulomatosis with Polyangiitis

“…In a case series reported by Wong et al in 2008, among 19 cases of CSA due to eosinophilia, 5 were diagnosed as EGPA (Churg-Strauss syndrome) (4). To our knowledge, there were another eight cases of EGPA complicated with CSA reported from 2009-2021 (5)(6)(7)(8)(9)(10)(11)(12). All cases were reported to be negative for ANCA.…”

Etiology of cutaneous vasculitis: utility of a systemic approach

“…CVs are classified based on clinical and histological data using the American College of Rheumatology (ACR) criteria since 1990 7 and the Chapel Hill Consensus Conference (CHCC) criteria issued in 1992 (revised in 2012) 8 ; although these classifications are not entirely satisfactory, they continue to be used in clinical practice 9 . Vasculitides are grouped according to the affected vessel size as: a) large vessel vasculitis, which includes giant cell arteritis and Takayasu arteritis 10 ; b) medium vessel vasculitis, such as polyarteritis nodosa (PAN), cutaneous PAN and Kawasaki's disease 11 ; and c) small vessel vasculitis, which can be granulomatous such as granulomatosis with polyangiitis, formerly known as Wegener granulomatosis 12 , and eosinophilia with polyangiitis, also known as Churg-Strauss Syndrome (SCS) 13 ; and non-granulomatous, which include microscopic polyangiitis (MPA) 14 , Schönlein-Henoch purpura (SHP) 15 , cutaneous leukocytoclastic vasculitis (LCV) 16 and essential cryoglobulinemia 17 .…”

A case report of myocardial infarction with non-obstructive coronary arteries as the initial presentation of eosinophilic granulomatosis with polyangiitis

“… 8 Coronary vasospasm, though rare, has been documented in EGPA. 5 , 6 , 9 While the exact mechanism of coronary vasospasm in EGPA is unclear, it is hypothesized that eosinophilic infiltration of the arterial walls leads to a cascade of chemokines and other inflammatory markers that cause segmental vasoconstriction of the coronary arteries. 9 …”