Cardiac eosinophilic granulomatosis with polyangiitis: rapid imaging with contrast CT and contrast echo aids early diagnosis

A 49-year-old male asthmatic (on Montelukast) with multiple sclerosis presented with shortness of breath and generalised weakness. On examination, he was in cardiac failure with a systolic murmur, rapid atrial fibrillation and weakness in all four limbs with slurred speech. His white cell count was 37x109/L, eosinophils 25x109/L, urea 13.6 mmol/L, creatinine 131 μmol/L, troponin I 4448 ng/L, anti-neutrophil cytoplasmic antibodies (ANCA) weakly positive (negative myeloperoxidase (MPO) and proteinase 3 (PR3)). Differential diagnoses included stroke, myocarditis and eosinophilic granulomatosis with polyangiitis (EGPA). Contrast echocardiography showed massive hypertrophy of the right ventricular apex and basal segments of the left ventricle (figure 1A) with severe mid-cavity obstruction (95 mm Hg gradient). A contrast CT of the chest showed right lung nodules and hilar lymphadenopathy, and confirmed the myocardial infiltration (figure 2). Brain MRI revealed multiple ischaemic foci throughout both cerebral hemispheres in keeping with a vasculitic aetiology. A clinical diagnosis of EGPA...

Source: Heart Asia - February 4, 2016 Category: Cardiology Authors: Abraham, D., Freeman, L. J. Tags: Images in cardiovascular medicine Source Type: research