Successful treatment for eosinophilic granulomatosis with polyangiitis causing severe myocarditis followed by cardiac magnetic resonance

Abstract

A 38-year-old woman had a history of asthma for 20 years. Bullous lesions had appeared in her left side of the back. Two months before admission, and biopsy revealed eosinophilic cellulitis. She experienced numbness in both legs one month later. She was admitted to our hospital for emergency treatment due to chest pain and loss of consciousness. Emergency coronary angiography revealed triple-vessel vasospasm. She had cardiac arrest for four minutes during the examination. We suspected eosinophilic granulomatosis with polyangiitis due to pulmonary infiltrate, eosinophilia, and a history of illness. We therefore started methylprednisolone pulse therapy. Although her condition and laboratory findings improved, cardiac magnetic resonance (CMR) imaging performed on day 16 showed myocardial edema and myocardial fibrosis on late gadolinium enhancement (LGE). Coronary angiography on day 35 revealed no spasm, and myocardial biopsy showed absence of vasculitis. There was no improvement in myocardial edema. CMR showed enlargement of LGE and formation of ventricular aneurysm. As myocarditis did not improve sufficiently, five courses of intravenous cyclophosphamide pulse therapy were administered. CMR on day 152 showed disappearance of the myocardial edema. We report a unique case of successful treatment of severe myocarditis and the usefulness of follow-up CMR.

Acute cerebral infarction caused by cardiac subvalvular thrombus shedding in eosinophilic myocarditis: a case description

“…The administration of mepolizumab, as a monoclonal antibody against interleukin-5 (IL-5), has been shown to result in a significant reduction in peripheral blood and tissue eosinophils. Although our patient unfortunately could not gain access to this drug, its therapeutic effect has been mentioned in some previous case reports ( 12 - 14 ). For example, Sakurai et al ( 14 ) reported a 50-year-old woman diagnosed as EGPA with cardiac involvement.…”