Abstract

Background: Cardiac involvement in Eosinophilic Granulomatosis with Polyangiitis (EGPA), formerly Churg-Strauss syndrome, is a rare but severe manifestation. Early diagnosis and immunosuppression are critical to avoid irreversible endomyocardial fibrosis.
Case Summary: A 36-year-old asthmatic woman presented with recurrent epigastric and a typical chest pain for several weeks. Initial gastrointestinal work-up was unremarkable. Transthoracic echocardiography showed a mild circumferential pericardial effusion with preserved left ventricular ejection fraction. Laboratory tests revealed marked hyper eosinophilia (9G/L), high CRP (85mg/L), and rising high-sensitivity troponin I (248→812ng/L). Within 48 hours, clinical deterioration occurred with worsening eosinophilia (36G/L), purpuric skin lesions, episcleritis, and peripheral neuropathy. EGPA related myopericarditis was suspected. High-dose corticosteroids (1mg/kg) were initiated urgently, leading to spectacular clinical and biological improvement within 24 hours. Cardiac mag3etic resonance imaging confirmed acute myopericarditis with diffuse myocardial edema and pericardial enhancement.
Discussion: This case emphasizes that in asthmatic patients with unexplained hyper eosinophilia, even atypical chest or epigastric pain should raise suspicion of eosinophilic myocarditis or EGPA. Early immunosuppressive therapy is essential to prevent life-threatening complications.

Keywords:Eosinophilic Granulomatosis with Polyangiitis; Myopericarditis; Churg-Strauss syndrome; Hyper eosinophilia