Zheng Tengfei, Song Ming, Zhong Ming, Meng Xiao
State Key Laboratory for Innovation and Transformation of Luobing Theory; Key Laboratory of Cardiovascular Remodeling and Function Research of MOE, NHC, CAMS and Shandong Province; Department of Cardiology, Qilu Hospital of Shandong University, Jinan, China.
Catheter Cardiovasc Interv. 2025 Aug;106(2):1255-1259. doi: 10.1002/ccd.31673. Epub 2025 Jun 8.
Hypereosinophilic syndrome (HES) is a rare hematologic disorder characterized by persistently elevated eosinophil counts, leading to organ involvement. While eosinophilic myocarditis and endocarditis are common manifestations, coronary artery spasm as a presenting feature of HES is rare. We present the case of a 41-year-old female with a 4-year history of asthma and chronic sinusitis who presented with a 6-month history of dizziness, headaches, and syncope. Despite normal brain CT and MRI, she was diagnosed with a patent foramen ovale (PFO) and underwent closure. However, her symptoms persisted, and she developed intermittent chest pain, which was relieved by nitrates. Further investigation revealed severe right coronary artery spasm, and HES was diagnosed after a comprehensive evaluation, including elevated eosinophil counts and eosinophilic infiltration in the colon. The patient was treated with prednisone, which led to normalization of eosinophil levels and resolution of her symptoms. Follow-up over 3 months showed no recurrence of dizziness or chest pain, and eosinophil counts remained within the normal range. This case highlights the importance of considering HES in the differential diagnosis of refractory coronary spasm and the value of early corticosteroid treatment. It also emphasizes the need for careful patient selection when considering PFO closure, as the procedure did not alleviate the patient's symptoms.
高嗜酸性粒细胞综合征（HES）是一种罕见的血液系统疾病，其特征是嗜酸性粒细胞计数持续升高，导致器官受累。虽然嗜酸性粒细胞性心肌炎和心内膜炎是常见表现，但冠状动脉痉挛作为HES的首发特征却很罕见。我们报告一例41岁女性病例，该患者有4年哮喘和慢性鼻窦炎病史，出现头晕、头痛和晕厥6个月。尽管脑部CT和MRI检查正常，但她被诊断为卵圆孔未闭（PFO）并接受了封堵术。然而，她的症状持续存在，并出现间歇性胸痛，硝酸酯类药物可缓解。进一步检查发现严重的右冠状动脉痉挛，综合评估（包括嗜酸性粒细胞计数升高和结肠嗜酸性粒细胞浸润）后诊断为HES。患者接受泼尼松治疗，嗜酸性粒细胞水平恢复正常，症状缓解。3个月的随访显示头晕或胸痛未复发，嗜酸性粒细胞计数保持在正常范围内。该病例强调了在难治性冠状动脉痉挛的鉴别诊断中考虑HES的重要性以及早期皮质类固醇治疗的价值。它还强调了在考虑PFO封堵时仔细选择患者的必要性，因为该手术并未缓解患者的症状。
