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Findings that shed new light on the possible pathogenesis of a disease or an adverse effect
CASE REPORT
Coronary artery vasospasm in a patient with Churg-Strauss syndrome
  1. Siddharth J Trivedi1,2,
  2. David Tanous1,2,
  3. Dan Suan2,3
  1. 1 Department of Cardiology, Westmead Hospital, Sydney, New South Wales, Australia
  2. 2 Westmead Clinical School, University of Sydney, Sydney, New South Wales, Australia
  3. 3 Division of Immunology, Garvan Institute of Medical Research, Sydney, New South Wales, Australia
  1. Correspondence to Dr Siddharth J Trivedi, Siddharth.Trivedi{at}health.nsw.gov.au

Summary

Patients with Churg-Strauss syndrome often suffer from unusual cardiac manifestations and sudden cardiac death. This differs from patients with other autoimmune disorders, who typically present with premature ischaemic heart disease. We report the case of a 56-year-old man with recurrent coronary vasospasm, including an inferoposterior ST-elevation myocardial infarction, complicated by bradycardic arrest. There was only minor coronary artery disease on coronary angiography. An elevated eosinophil count was noted. His medical history included allergic rhinitis with polyposis, adult-onset asthma and biopsy-proven eosinophilic oesophagitis. Review of his sinus biopsies demonstrated blood vessels with marked accumulation of eosinophils in extravascular areas. The patient, therefore, met the American College of Rheumatology criteria for Churg-Strauss syndrome. The patient was commenced on immunosuppression, with the return of the eosinophil count to within normal limits, and remains free of cardiovascular events over 24 months.

  • immunology
  • cardiovascular medicine

https://doi.org/10.1136/bcr-2018-225321

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    Footnotes

    • Contributors SJT, DT and DS: involved in the inpatient and outpatient management of the patient. SJT, DT and DS: planned and conceptualised the design of the case report. SJT: wrote the first draft of the manuscript. DT and DS:reviewed and edited the manuscript. All authors have approved the final version of the 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.

    • Correction notice This article has been corrected since it published Online. The authors noticed a spacing error in the article title.