Coronary involvement in Churg-Strauss syndrome: a case report with CT findings

Area of Science:

• Cardiology
• Rheumatology
• Immunology

Background:

• Churg-Strauss syndrome (CSS), also known as eosinophilic granulomatosis with polyangiitis (EGPA), is a rare systemic vasculitis.
• It is characterized by asthma, hypereosinophilia, and positive antineutrophil cytoplasmic antibodies (ANCAs).
• Cardiac involvement in CSS typically manifests as eosinophilic myocarditis or pericarditis.

Observation:

• A 69-year-old male with a history of asthma, sinusitis, hypereosinophilia, and polyneuropathy was diagnosed with CSS.
• Despite the absence of specific cardiac symptoms, coronary CT angiography (CCTA) revealed vasculitis and a saccular aneurysm in the proximal coronary arteries.
• A 3-year follow-up CCTA showed progression of coronary artery wall thickening and infiltration.

Findings:

• This case demonstrates coronary artery vasculitis and aneurysm formation in a patient with CSS.
• The findings suggest that major coronary arteries can be involved in CSS, contrary to its less prominent feature.
• Coronary CT angiography is effective in visualizing these vascular abnormalities.

Implications:

• The study suggests that coronary artery involvement should be considered in patients diagnosed with CSS, even in the absence of cardiac symptoms.
• Routine cardiac screening, including advanced imaging like CCTA, may be warranted in CSS patients.
• This case expands the understanding of the spectrum of cardiovascular manifestations in CSS.