Hypereosinophilic Syndrome Presenting as Coronary Artery Spasm and ST-Segment Elevation Myocardial Infarction.

BACKGROUND

Hypereosinophilic syndrome (HES) is characterized by high absolute eosinophil count and multiorgan damage. Energy drink consumption (EDC) is associated with adverse cardiovascular events, including coronary artery spasm (CAS).

CASE SUMMARY: A 31-year-old man with asthma and excessive EDC presented with chest pain, hypotension, and inferior ST-segment elevation myocardial infarction with elevated troponin to 1,081 ng/L. Given persistent CAS refractory to coronary vasodilators, he underwent balloon angioplasty of the right coronary artery and first diagonal branch. Despite initial improvement, his absolute eosinophil count and systemic symptoms worsened. Gastrointestinal, pulmonary, and bone marrow biopsies demonstrated eosinophilic infiltration. He achieved remission with corticosteroids.

DISCUSSION: ST-segment elevation myocardial infarction from CAS is a rare cardiac manifestation of HES. The multidisciplinary management requires pharmacologic and interventional therapies to reduce inflammation and prevent cardiovascular sequelae.

TAKE-HOME MESSAGE: This case highlights the importance of early recognition and treatment HES in patients with unexplained myocardial infarction, particularly when associated with EDC and the absence of atherosclerotic risk factors.