Case report of eosinophilic granulomatosis with polyangitis presenting as acute myocarditis

Abstract

Patient had fever and general fatigue while on holiday. Day 0 On the flight back home, he had progressive chest pain, dyspnea, and syncope. Day 0-2 h after admission At hospital admission, elevated inflammatory markers and positive troponins were observed. Electrocardiogram showed atrial fibrillation at 160 beats/min and new onset complete right bundle branch block (RBBB). Day 0-12 h after admission Transthoracic echocardiogram (TTE), computer tomography, and coronary angiogram were performed.Day 2 Cardiac magnetic resonance (CMR) was performed.Day 7 Endomyocardial biopsy showed eosinophilic myocarditis. Treatment with high-dose corticosteroids started. Within 21 days from admissionThe patient was diagnosed with eosinophilic granulomatosis with polyangitis (EGPA) and was treated by high-dose corticosteroids and intravenous cyclophosphamide.2 months after discharge Repeated TTE and CMR showed stationary results. The eosinophilic count was normal, and the patient was doing well. Treatment is planned to continue with methotrexate and prednisolone in tapering doses.

Cardiac magnetic resonance in histologically proven eosinophilic myocarditis

“…These observations fit well inside the spectrum of our data. Curiously, and in striking discord with our work, cases of acute necrotizing EM free of any CMR abnormality, save for small pericardial effusion, have also been reported [ 13 , 14 ]. None of our patients had normal or near normal CMR.…”