Chatta Payush, Park Eunwoo, Ghatnekar Nikhil, Kirk Shannon, Hilliard Anthony, Parwani Purvi
Division of Internal Medicine, Department of Medicine, Loma Linda University Medical Center, 11234 Anderson St, Loma Linda, CA 92354, USA.
Division of Cardiology, Department of Internal Medicine, Loma Linda University Medical Center, 11234 Anderson St, Loma Linda, CA 92354, USA.
Eur Heart J Case Rep. 2022 Jan 19;6(1):ytac021. doi: 10.1093/ehjcr/ytac021. eCollection 2022 Jan.
Eosinophilic granulomatosis with polyangiitis (EGPA) is a multisystem disorder commonly affecting the lung and skin, with cardiovascular involvement found in up to 60% of patients. We present a case of myocardial infarction with non-obstructive coronary arteries (MINOCA) as the initial presentation of EGPA.
A 52-year-old female with past medical history of asthma, recurrent sinusitis, and peripheral neuropathy presented to our hospital with chest pain, rash, acute vision loss, elevated troponin, and peripheral eosinophilia. Electrocardiogram showed no ischaemic changes and coronary angiography displayed normal coronary anatomy. On a subsequent visit, cardiac magnetic resonance (CMR) showed predominant focal anteroseptal and inferoseptal akinesis with focal sub-endocardial delayed enhancement, indicative of a myocardial infarction involving the septal branches of the left anterior descending artery. Due to the focal findings on CMR, peripheral eosinophilia, and rash, the patient was evaluated for EGPA. Rheumatologic workup and skin biopsy were suggestive of small vessel vasculitis. The patient was diagnosed with multi-organ EGPA, involving the coronaries, which was ultimately thought to be the aetiology of her MINOCA. Following steroid and monoclonal antibody therapy, the patient experienced notable improvement in her cardiac function at follow-up appointments.
This is a unique case MINOCA as the initial presentation of EGPA. Considering the heterogeneous disease presentation of those diagnosed with MINOCA, utilization of CMR is essential to guide diagnosis and management of such patients.
嗜酸性肉芽肿性多血管炎（EGPA）是一种多系统疾病，常见于肺部和皮肤，高达60%的患者会出现心血管受累。我们报告一例以非阻塞性冠状动脉心肌梗死（MINOCA）为EGPA首发表现的病例。
一名52岁女性，有哮喘、复发性鼻窦炎和周围神经病变病史，因胸痛、皮疹、急性视力丧失、肌钙蛋白升高和外周血嗜酸性粒细胞增多前来我院就诊。心电图显示无缺血性改变，冠状动脉造影显示冠状动脉解剖结构正常。在随后的一次就诊中，心脏磁共振成像（CMR）显示主要为前间隔和下间隔局部运动减弱，伴有局部心内膜下延迟强化，提示涉及左前降支间隔支的心肌梗死。由于CMR上的局部表现、外周血嗜酸性粒细胞增多和皮疹，对该患者进行了EGPA评估。风湿学检查和皮肤活检提示小血管血管炎。该患者被诊断为多器官EGPA，累及冠状动脉，最终认为这是她MINOCA的病因。在接受类固醇和单克隆抗体治疗后，患者在随访时心脏功能有显著改善。
这是一例独特的以MINOCA为EGPA首发表现的病例。鉴于MINOCA患者疾病表现的异质性，CMR的应用对于指导此类患者的诊断和管理至关重要。
