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Acute heart failure: on the track of a rare disease
  1. Joana Andrade1,2,
  2. André Freitas2,
  3. Susana Costa2 and
  4. Rui Baptista2,3
  1. 1Internal Medicine Department, Centro Hospitalar Tondela Viseu EPE, Viseu, Portugal
  2. 2Cardiology Department, Centro Hospitalar e Universitario de Coimbra EPE, Coimbra, Portugal
  3. 3Faculty of Medicine, University of Coimbra, Coimbra, Portugal
  1. Correspondence to Dr Joana Andrade; joana.andrade99{at}gmail.com

Abstract

Eosinophilic granulomatosis with polyangiitis is an antineutrophil cytoplasmic antibody (ANCA)-associated small vessel vasculitis with cardiac involvement in more than 60% of cases. Authors describe the case of a 48-year-old woman who presented with progressively worsening asthenia, dyspnoea and macular, non-painful, non-itchy cutaneous lesions. She had signs of congestion on clinical examination and a history of asthma and nasal polyps. Blood tests showed eosinophilia (11.2%), positive troponin I (9698 μg/L), elevated B-type natriuretic peptide (2047 pg/mL) and positive C reactive protein (6.68 mg/dL). Echocardiogram displayed moderate left ventricular enlargement, left ventricular ejection fraction of 28% and mild pericardial effusion. Levosimendan relieved the congestion. Additional testing confirmed positive antinuclear antibodies with ANCA-negative autoimmune pattern. Cardiac magnetic resonance showed severely depressed systolic function due to diffuse hypokinesia. Cardiac biopsy had intercellular oedema and eosinophilic infiltrate. Treatment with prednisolone and cyclophosphamide was started. This is a case of a rare disease presenting with life-threatening cardiac involvement.

  • vasculitis
  • biological agents
  • heart failure
  • immunology

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Footnotes

  • Contributors All the authors have contributed to the clinical approach and to the planning, conducting and reporting of the described clinical case. AF made the first diagnostic approach in the emergency room department, identified the acute heart failure and presented the first possible differential diagnosis. Then, together with JA and SC followed the patient during all the hospital admission time, discussing all the details in order to achieve the correct diagnose and start the adequate treatment. RB followed the patient after discharge to access the outcome and the long-term evolution. Regarding the case report, JA and AF collected the data and then, together with SC and RB, made the analysis and interpretation of all the available results and details of the clinical case. JA was responsible for the conception and design of the paper with the valuable collaboration of all the coauthors.

  • 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.

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