[Well's syndrome with eosinophilic vasculitis, coronary aneurysms and myocardial infarction]

This report describes a 40-year-old man suffering from Well's syndrome (recurrent granulomatous dermatitis with eosinophilia) who presented an anterior myocardial infarction complicated by shock and 3rd degree A-V block. The patient died within 12 hours of admission to the hospital. At autopsy, both main coronary arteries showed proximal aneurysms occluded by thrombi. On light microscopy, the aneurysmatic coronary walls were infiltrated by numerous eosinophils, lymphocytes and plasma cells. Similar cellulitis, mainly perivascular, was found in kidneys and anterior mediastinum. Because the patient had been treated with large doses of diclofenac and piroxicam owing to painful arthralgias, the Authors discuss the possible allergic pathogenesis of the vasculitis.