Eosinophilic granulomatosis with polyangiitis: myocardial thickening reversed by corticosteroids

What is it about?

A 53-year old man with a history of asthma and nasal polyposis presented with acute chest pain and elevated troponin; a percutaneous coronary intervention was performed. The left ventricle was described as hypertrophic. After 20 days the myocardium had markedly increased in thickness of both the right and left ventricle. Evaluation revealed hypereosinophilia in the blood and nasal mucosal tissue, which confirmed the diagnosis of eosinophilic granulomatosis with polyangiitis. He presented with signs of active vasculitis including weight loss, tiredness, intracerebral hemorrhage, and increasing serum creatinine. After 6 days of corticosteroid treatment, the myocardium returned to its initial thickness.

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Why is it important?

Eosinophilic granulomatosis with polyangiitis may affect the heart and cardiac involvement is the most common cause of mortality. Treatment with corticosteroids is effective at reducing both morbidity and mortality, therefore it is of importance to consider the diagnosis and perform examinations such as cardiac magnetic resonance tomography and endomyocardial biopsy. This case demonstrates the remarkable and rapid regression of myocardial edema and eosinophilic infiltrates that is possible after initiation of corticosteroids.