JACC. Case reports · 2026
Cardiac Manifestations of EGPA: An Overlap Phenotype of Inflammatory Myocardial Injury and Takotsubo-Like Syndrome.
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Shalit Bernard, Buonomo Giancarlo, Shaw Dustin G, Grisé Alison P
Аннотация
BACKGROUND: Eosinophilic granulomatosis with polyangiitis (EGPA) often presents with eosinophilic myocarditis, but the spectrum of cardiac findings is scarcely reported. We describe a case of EGPA with an unusual presentation of acute left ventricular (LV) dysfunction associated with lymphocyte-predominant myocardial inflammation and Takotsubo-like syndrome with LV thrombus.
CASE SUMMARY: A 42-year-old woman with history of asthma presented with chronic cough, dyspnea, and rash. Findings of peripheral eosinophilia, cutaneous vasculitis, mononeuritis multiplex, and myocardial inflammation confirmed antineutrophil cytoplasmic antibodies-negative EGPA. Her course was complicated by transient severe LV systolic dysfunction with Takotsubo-like regional wall-motion abnormalities, lymphocyte-predominant myocardial inflammation on biopsy, and LV thrombus. Management included pulse-dosed steroids, rituximab, and mepolizumab.
DISCUSSION: Although EGPA frequently causes cardiac manifestations, typically eosinophilic myocarditis, an overlap phenotype of inflammatory myocardial injury, Takotsubo-like cardiomyopathy, and LV thrombus is exceedingly rare.
TAKE-HOME MESSAGES: Cardiac involvement remains the leading cause of mortality in EGPA. This case highlights the heterogeneity of its cardiac phenotypes, illustrating the importance of early cardiology evaluation and diagnostics.
CASE SUMMARY: A 42-year-old woman with history of asthma presented with chronic cough, dyspnea, and rash. Findings of peripheral eosinophilia, cutaneous vasculitis, mononeuritis multiplex, and myocardial inflammation confirmed antineutrophil cytoplasmic antibodies-negative EGPA. Her course was complicated by transient severe LV systolic dysfunction with Takotsubo-like regional wall-motion abnormalities, lymphocyte-predominant myocardial inflammation on biopsy, and LV thrombus. Management included pulse-dosed steroids, rituximab, and mepolizumab.
DISCUSSION: Although EGPA frequently causes cardiac manifestations, typically eosinophilic myocarditis, an overlap phenotype of inflammatory myocardial injury, Takotsubo-like cardiomyopathy, and LV thrombus is exceedingly rare.
TAKE-HOME MESSAGES: Cardiac involvement remains the leading cause of mortality in EGPA. This case highlights the heterogeneity of its cardiac phenotypes, illustrating the importance of early cardiology evaluation and diagnostics.