Abdominal pain as the sole initial manifestation of ANCA-positive EGPA with myocarditis: a case report and literature review.

BACKGROUND

Eosinophilic granulomatosis with polyangiitis (EGPA) typically presents with asthma, but we report an anti-neutrophil cytoplasmic antibody (ANCA)-positive EGPA case with an unusual presentation: isolated abdominal pain as the initial manifestation of systemic vasculitis, which progressed rapidly to life-threatening cardiac involvement in the absence of overt respiratory symptoms at onset.

CASE PRESENTATION: A 70-year-old female presented with abdominal pain and was found to have eosinophilia with elevated cardiac biomarkers. Despite normal coronary angiography, cardiac magnetic resonance revealed left ventricular hypoperfusion and an apical thrombus, leading to a diagnosis of eosinophilic myocarditis and vasculitis by biopsy. Symptoms and thrombus resolved with glucocorticoids without anticoagulation. Cyclophosphamide was added for persistent cardiac dysfunction.

CONCLUSIONS

ANCA-positive EGPA can present atypically with isolated abdominal pain and rapid cardiac involvement. Therefore, this triad warrants urgent evaluation and early immunosuppression. Thrombus resolution without anticoagulation further supports an inflammation-driven pathology.