Myocarditis as the first manifestation of eosinophilic granulomatosis with polyangiitis
Introduction. Myocarditis is not a rare diagnosis, but its etiology often remains unknown as it requires extensive diagnostic work. Eosinophilic granulomatosis with polyangiitis (EGPA) or Churg-Strauss syndrome is a very rare systemic disease that is not easy to diagnose. Myocarditis in EGPA is unco...
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| Language: | English |
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Ministry of Defence of the Republic of Serbia, University of Defence, Belgrade
2023-01-01
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| Series: | Vojnosanitetski Pregled |
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| Online Access: | https://doiserbia.nb.rs/img/doi/0042-8450/2023/0042-84502300026D.pdf |
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| author | Đorđević-Radojković Danijela Apostolović Svetlana Damjanović Miodrag Kostić Tomislav Fejsa-Levakov Aleksandra Dimitrijević Marko Janković-Tomašević Ružica Dakić Sonja Božinović Nenad Pavićević Milena |
| author_facet | Đorđević-Radojković Danijela Apostolović Svetlana Damjanović Miodrag Kostić Tomislav Fejsa-Levakov Aleksandra Dimitrijević Marko Janković-Tomašević Ružica Dakić Sonja Božinović Nenad Pavićević Milena |
| author_sort | Đorđević-Radojković Danijela |
| collection | DOAJ |
| description | Introduction. Myocarditis is not a rare diagnosis, but its etiology often remains unknown as it requires extensive diagnostic work. Eosinophilic granulomatosis with polyangiitis (EGPA) or Churg-Strauss syndrome is a very rare systemic disease that is not easy to diagnose. Myocarditis in EGPA is uncommon and usually occurs in the late stages of the disease. Case report. A 22-year-old man was admitted with acute coronary syndrome. Using coronary angiography, the presence of stenoses on the epicardial coronary arteries was ruled out, and a working diagnosis of myocardial infarction with non-obstructive coronary arteries (MINOCA) was established. Then, we found inflammatory syndrome, eosinophilia, and a lot of systemic symptoms and signs. The diagnostic work included extensive laboratory tests, which ruled out infectious agents. Then, immunological tests, a computed tomography scan of the chest, cardiac magnetic reso-nance imaging (MRI) and a biopsy of the bone marrow, nasal mucosa, and skin were performed. We managed to establish the diagnosis of myopericarditis by cardiac MRI. The cause of myocarditis – EGPA, was found only after the histopathological finding of the skin biopsy, which enabled ad-equate immunosuppressive therapy. Conclusion. The accurate diagnosis was crucial for the correct, causal treatment of the patient, especially because he needed life-long immunosuppressive therapy. In order for such complex patients to receive adequate treatment, a multidisciplinary approach and perseverance in the diagnostic evaluation of the etiology of myocarditis are necessary. |
| format | Article |
| id | doaj-art-b62a63b7e1d54701b36f1ea9997453b8 |
| institution | OA Journals |
| issn | 0042-8450 2406-0720 |
| language | English |
| publishDate | 2023-01-01 |
| publisher | Ministry of Defence of the Republic of Serbia, University of Defence, Belgrade |
| record_format | Article |
| series | Vojnosanitetski Pregled |
| spelling | doaj-art-b62a63b7e1d54701b36f1ea9997453b82025-08-20T02:00:17ZengMinistry of Defence of the Republic of Serbia, University of Defence, BelgradeVojnosanitetski Pregled0042-84502406-07202023-01-01801194294810.2298/VSP230218026D0042-84502300026DMyocarditis as the first manifestation of eosinophilic granulomatosis with polyangiitisĐorđević-Radojković Danijela0Apostolović Svetlana1https://orcid.org/0000-0001-9015-297XDamjanović Miodrag2Kostić Tomislav3https://orcid.org/0000-0002-5402-5153Fejsa-Levakov Aleksandra4Dimitrijević Marko5Janković-Tomašević Ružica6Dakić Sonja7Božinović Nenad8https://orcid.org/0000-0003-0515-7923Pavićević Milena9University Clinical Center Niš, Cardiology Clinic, Niš, Serbia + University of Niš, Faculty of Medicine, Niš, SerbiaUniversity Clinical Center Niš, Cardiology Clinic, Niš, Serbia + University of Niš, Faculty of Medicine, Niš, SerbiaUniversity Clinical Center Niš, Cardiology Clinic, Niš, SerbiaUniversity Clinical Center Niš, Cardiology Clinic, Niš, Serbia + University of Niš, Faculty of Medicine, Niš, SerbiaUniversity of Novi Sad, Faculty of Medicine, Novi Sad, Serbia + University Clinical Center of Vojvodina, Novi Sad, SerbiaGeneral Hospital Zaječar, Zaječar, SerbiaUniversity Clinical Center Niš, Cardiology Clinic, Niš, SerbiaUniversity Clinical Center Niš, Cardiology Clinic, Niš, Serbia + University of Niš, Faculty of Medicine, Niš, SerbiaUniversity Clinical Center Niš, Cardiology Clinic, Niš, Serbia + University of Niš, Faculty of Medicine, Niš, SerbiaUniversity Clinical Center Niš, Cardiology Clinic, Niš, SerbiaIntroduction. Myocarditis is not a rare diagnosis, but its etiology often remains unknown as it requires extensive diagnostic work. Eosinophilic granulomatosis with polyangiitis (EGPA) or Churg-Strauss syndrome is a very rare systemic disease that is not easy to diagnose. Myocarditis in EGPA is uncommon and usually occurs in the late stages of the disease. Case report. A 22-year-old man was admitted with acute coronary syndrome. Using coronary angiography, the presence of stenoses on the epicardial coronary arteries was ruled out, and a working diagnosis of myocardial infarction with non-obstructive coronary arteries (MINOCA) was established. Then, we found inflammatory syndrome, eosinophilia, and a lot of systemic symptoms and signs. The diagnostic work included extensive laboratory tests, which ruled out infectious agents. Then, immunological tests, a computed tomography scan of the chest, cardiac magnetic reso-nance imaging (MRI) and a biopsy of the bone marrow, nasal mucosa, and skin were performed. We managed to establish the diagnosis of myopericarditis by cardiac MRI. The cause of myocarditis – EGPA, was found only after the histopathological finding of the skin biopsy, which enabled ad-equate immunosuppressive therapy. Conclusion. The accurate diagnosis was crucial for the correct, causal treatment of the patient, especially because he needed life-long immunosuppressive therapy. In order for such complex patients to receive adequate treatment, a multidisciplinary approach and perseverance in the diagnostic evaluation of the etiology of myocarditis are necessary.https://doiserbia.nb.rs/img/doi/0042-8450/2023/0042-84502300026D.pdfdiagnosishistological techniquesmyocarditiseosinophiliachurg-strauss syndrome |
| spellingShingle | Đorđević-Radojković Danijela Apostolović Svetlana Damjanović Miodrag Kostić Tomislav Fejsa-Levakov Aleksandra Dimitrijević Marko Janković-Tomašević Ružica Dakić Sonja Božinović Nenad Pavićević Milena Myocarditis as the first manifestation of eosinophilic granulomatosis with polyangiitis Vojnosanitetski Pregled diagnosis histological techniques myocarditis eosinophilia churg-strauss syndrome |
| title | Myocarditis as the first manifestation of eosinophilic granulomatosis with polyangiitis |
| title_full | Myocarditis as the first manifestation of eosinophilic granulomatosis with polyangiitis |
| title_fullStr | Myocarditis as the first manifestation of eosinophilic granulomatosis with polyangiitis |
| title_full_unstemmed | Myocarditis as the first manifestation of eosinophilic granulomatosis with polyangiitis |
| title_short | Myocarditis as the first manifestation of eosinophilic granulomatosis with polyangiitis |
| title_sort | myocarditis as the first manifestation of eosinophilic granulomatosis with polyangiitis |
| topic | diagnosis histological techniques myocarditis eosinophilia churg-strauss syndrome |
| url | https://doiserbia.nb.rs/img/doi/0042-8450/2023/0042-84502300026D.pdf |
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