Churg-Strauss syndrome-associated heart failure and left ventricular thrombosis

Abstract

We present a case of a 47-year-old woman with a history of asthma and mononeuritis who presented with shortness of breath and fatigue. Heart failure was diagnosed and echocardiography revealed large floating thrombi attached to the left ventricular walls. Cardiac magnetic resonance imaging showed evidence of myocarditis and angiitis. Blood count revealed eosinophilia. She was diagnosed with eosinophilic granulomatosis with polyangiitis or Churg-Strauss syndrome (CSS) according to recently updated criteria. Medical management with specific aetiology (anticoagulation or immunosuppression) and heart failure treatment resulted in clinical improvement. We further discuss the diagnostic approach of CSS with cardiovascular complications and therapeutic management.

Keywords: Churg-Strauss syndrome; Eosinophilic granulomatosis with polyangiitis; Heart failure; Left ventricular thrombus; Myocarditis.

Figure 1

The patient's electrocardiogram on admission revealing sinus rhythm, 90/min, and QS waves in leads V1–V4.

Figure 2

Transthoracic echocardiogram with multiple large and smaller floating thrombi attached to the left ventricular walls. Largest thrombus measured 1.52 × 3.59 cm.

Figure 3

Thickening of the maxillary sinuses in facial computed tomography scan highlighted with small red arrows.

Figure 4

Lung consolidation indicated by thick arrow and ground glass opacities indicated by thin arrows in patient's chest computed tomography.

Figure 5

Cardiac magnetic resonance demonstrating subendocardial late gadolinium enhancement (LGE) consistent with angiitis‐induced ischaemia (red arrows), oedema (in T2 sequence), and transmural LGE in posterior wall and pericardium (yellow arrow).

Figure 6

Timeline of patient's clinical history and EGPA manifestations. CSS, Churg–Strauss syndrome; EGPA, eosinophilic granulomatosis with polyangiitis; HF, heart failure; LV, left ventricular.