Effective Treatment with an Interleukin-5 Inhibitor for Recurrent Life-threatening Coronary Spastic Angina with Hypereosinophilia.

A 39-year-old man with asthma and chronic sinusitis presented with nocturnal chest pain and a loss of consciousness. Blood tests showed elevated myocardial enzyme levels and eosinophilia, but the coronary angiography results were unremarkable. Although the patient was treated with vasodilators, chest pain with ST elevation recurred, leading to a diagnosis of refractory coronary spastic angina (CSA) with hypereosinophilia. Prednisolone (PSL) was initially effective, but symptoms recurred during dose reduction. After initiation of mepolizumab, an interleukin-5 (IL-5) inhibitor, his symptoms improved, allowing tapering of PSL. This case indicates that IL-5 inhibitors can be useful glucocorticoid-sparing agents for recurrent CSA associated with eosinophilia.