Refractory Coronary Vasospasms in a Patient With Eosinophilic Granulomatosis With Polyangiitis

Coronary vasospasms refractory to calcium channel blockers and nitrates may be secondary to a systemic process. Although rare, eosinophilic granulomatosis with polyangiitis (EGPA) can cause coronary vasospasms.

A 33-year-old woman presented with recurrent chest pain leading to multiple episodes of cardiac arrest. Rising eosinophilia and coronary intimal thickening were noted, and cardiac magnetic resonance imaging showed scarring. Owing to the high index of suspicion for EGPA, she was started on steroid therapy and cyclophosphamide. With this treatment, she had no further episodes of cardiac symptoms.

Cardiac involvement in EGPA is rare and carries a poor prognosis. The most common cardiac manifestations are congestive heart failure, pericarditis, myocarditis, and arrhythmias.

EGPA should be considered in the differential diagnosis for patients with refractory coronary vasospasms and eosinophilia >10%. EGPA cannot be ruled out solely based on the absence of antineutrophil cytoplasmic antibodies, particularly in patients with cardiac involvement.