Perimyocarditis and myocardial infarction: A rare manifestation of Churg-Strauss syndrome

Abstract

The present article reports a case involving a 58-year-old man without cardiovascular risk factors who was admitted to hospital with acute coronary syndrome. Coronary angiography revealed high-grade arteriosclerotic stenosis of the mid-left anterior descending coronary artery and 80% proximal intermediate branch stenosis, which were treated using three drug-eluting stents. Churg-Strauss syndrome was diagnosed based on the patient's history of asthma, sinusitis, eosinophilia, nasal polyps, transient radiological pulmonary infiltrations and transient paresthesia over the left tibia, and eosinophilic pericardial effusion and eosinophilic infiltrations revealed in a myocardial biopsy. Treatment with prednisone was initiated, followed by treatment with cyclophosphamide. Eosinophil levels returned to normal after nine days of treatment. There is evidence that Churg-Strauss syndrome may promote arteriosclerosis.

Keywords: Acute coronary syndrome; Arteriosclerosis; Churg-Strauss syndrome; Eosinophilia; Myocardial infarction.

Figure 1)

Electrocardiogram showing ST wave depressions in the inferior leads

Figure 2)

Coronary angiography showing high-grade arteriosclerotic stenosis of the mid-left anterior descending coronary artery (LAD)

Figure 3)

Coronary angiography showing 80% proximal intermediate branch stenosis

Figure 4)

Pericardial tap showing eosinophilic pericardial effusion. Hematoxylin-eosin stain, original magnification ×40. Image supplied by Dr Beatrix Bösch, Institute of Pathology, Triemlispital, Zürich, Switzerland

Figure 5)

Eosinophilic interstitial infiltrates in a myocardial biopsy specimen. Hematoxylin-eosin stain, original magnification ×40. Image supplied by Dr Beatrix Bösch, Institute of Pathology, Triemlispital, Zürich, Switzerland.