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Unusual association of diseases/symptoms
CASE REPORT
Myopericarditis as a presentation of eosinophilic granulomatosus with polyangiitis (EGPA)
  1. Mrinalini Dey1,2,
  2. Jagdish Nair2,
  3. Rajiv Sankaranarayanan3 and
  4. Prathap Kanagala3
  1. 1 Department of Musculoskeletal Biology I, Institute of Ageing and Chronic Disease, University of Liverpool Faculty of Health and Life Sciences, Liverpool, UK
  2. 2 Department of Academic Rheumatology, Aintree University Hospitals NHS Foundation Trust, Liverpool, UK
  3. 3 Department of Cardiology, Aintree University Hospitals NHS Foundation Trust, Liverpool, UK
  1. Correspondence to Dr Mrinalini Dey, mrinalini.dey{at}nhs.net

Abstract

A 60-year-old woman was admitted to the hospital with worsening dyspnoea, cough and chest pain. This was on a background of weight loss, decreased appetite, mononeuritis multiplex, chronic eosinophilia and a single episode of a non-blanching rash. Investigations demonstrated a raised troponin and ischaemic changes on ECG, and she was therefore initially treated for a presumed myocardial infarction. However, her symptoms failed to improve with treatment for the acute coronary syndrome. A coronary angiogram revealed no significant flow-limiting disease, and further investigations yielded confirmation of raised eosinophils and a positive perinuclear antineutrophil cytoplasmic antibody test. An echocardiogram demonstrated a pericardial effusion, and subsequent cardiac magnetic resonance features were compatible with myopericarditis. In light of these findings, the patient was diagnosed with eosinophilic granulomatous with polyangiitis and commenced on high-dose intravenous methylprednisolone and cyclophosphamide. She made an excellent recovery and remains in remission on azathioprine and a tapering dose of corticosteroids.

  • pericardial disease
  • vasculitis

https://doi.org/10.1136/bcr-2019-230593

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    Footnotes

    • Contributors All authors contributed substantially to the design of this work, the acquisition and interpretation of data, drafting of the manuscript and final approval of version to be submitted. MD: analysed and interpreted the data, and drafted the final manuscript. JN: analysed and interpreted the data, and edited and approved the final manuscript. RS: acquired the data, and edited and approved the final manuscript. PK: acquired, analysed and interpreted the data, analysed and collated the images, and edited and approved the final manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Patient consent for publication Obtained.