Acute coronary syndrome associated with Churg-Strauss syndrome

Area of Science:

• Cardiology
• Rheumatology
• Internal Medicine

Background:

• Churg-Strauss syndrome, also known as eosinophilic granulomatosis with polyangiitis, is a rare systemic vasculitis characterized by asthma, eosinophilia, and granulomatous inflammation.
• Cardiac involvement is a serious complication of Churg-Strauss syndrome, often presenting with diverse clinical manifestations including coronary artery disease and myocarditis.

Observation:

• A 41-year-old female with a history of asthma, chronic sinusitis, and eosinophilic proctitis presented with acute dyspnea and chest pain.
• Electrocardiogram revealed anterior ST-segment elevations and inferior ST-segment depression, suggesting acute cardiac ischemia.
• Cardiac catheterization showed a reversible occlusion of the left anterior descending coronary artery after nitroglycerine administration.

Findings:

• Cardiac magnetic resonance imaging confirmed findings consistent with perimyocarditis.
• Laboratory investigations revealed significant hypereosinophilia and elevated immunoglobulin E (IgE) levels.
• The patient was diagnosed with Churg-Strauss syndrome based on clinical presentation, cardiac findings, and laboratory results.

Implications:

• This case underscores the importance of considering Churg-Strauss syndrome in patients presenting with acute cardiac events, particularly those with a history of asthma and eosinophilia.
• Early diagnosis and management of cardiac involvement in Churg-Strauss syndrome are crucial for improving patient outcomes and preventing long-term cardiovascular complications.
• The reversible nature of the coronary artery occlusion in this case highlights the potential for inflammatory processes to mimic acute coronary syndromes.