A rare case of eosinophilic granulomatosis with polyangiitis complicated with progressive pericardial effusion

• Published in: Journal of cardiology cases 2017-05, Vol.15 (5), p.163-166
• Main Authors: Arinaga, Toyonori, MD, Komaki, Tomo, MD, Miura, Shin-ichiro, MD, FJCC, Futami, Makito, MD, Morii, Joji, MD, Sugihara, Makoto, MD, Saku, Keijiro, MD, FJCC
• Format: Article
• Language: English
• Subjects: Cardiovascular; Eosinophilic granulomatosis with polyangiitis; Eosinophilic pneumonia; Myopericarditis; Progressive pericardial effusion
• ISSN: 1878-5409; 1878-5409
• DOI: 10.1016/j.jccase.2017.01.001

Abstract A 44-year-old woman had a 15-year history of asthma and had recently been treated for sinusitis and unidentified limb eruption. She had presented at a nearby clinic with inspiratory chest pain one week before hospitalization, and was diagnosed as having eosinophilic pneumonia based on peripheral blood eosinophilia and ground glass opacities in the right lung field, without pericardial effusion, as detected by chest computed tomography. She additionally presented with a feeling of chest tightness, and extensive pericardial effusion appeared within a week. She developed heart failure on admission, and we performed pericardiocentesis. We gave a clinical diagnosis of acute probable myopericarditis as the cause of pericardial effusion based on pleuritic chest pain, pericardial effusion, and elevation of cardiac enzymes, as well as eosinophilic granulomatosis with polyangiitis (EGPA) based on eosinophilia, her history of sinusitis, asthma, and migratory pulmonary opacities. We initiated oral prednisone 25 mg daily and pericardial effusion disappeared. In patients with EGPA, cardiac involvement is more serious than the involvement of other organs, and is associated with a poor prognosis. In this report we describe a rare case of EGPA complicated with progressive pericardial effusion and discuss the importance of the early diagnosis and treatment of EGPA. < Learning objective: Eosinophilic granulomatosis with polyangiitis (EGPA), or Churg Strauss syndrome, is a multisystem disorder. It is important for patients with EGPA complicated with cardiac involvement to be diagnosed and treated early because cardiac involvement may lead to a fatal outcome.>