Eosinophilic Myocarditis due to Churg-Strauss Syndrome With Markedly Elevated Eosinophil Cationic Protein
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概要
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A 67-year-old woman with asthma visited our hospital with increasing dyspnea and new-onset paresthesia and purpura in her legs. Physical examination showed a wheeze, pretibial edema, and surrounding purpura. Chest X-rays showed cardiac decompensation and an electrocardiogram revealed a new ST-T change. Laboratory data showed leukocytosis, hypereosinophilia (10,450/<I>μ</I>L), troponin T(+), elevated BNP, and markedly elevated eosinophil cationic protein (ECP) (> 150 ng/mL). Echocardiography revealed diffuse left ventricular hypokinesis (ejection fraction 30%) with increased wall thickness. Coronary angiography was normal. Cardiac magnetic resonance imaging implied diffuse myocardial edema and subendocardial late gadolinium enhancement. Skin biopsy of purpura showed superfi cial perivascular dermatitis with remarkable eosinophilic infiltrations. No evidence of drug allergies, parasitic infection, or myeloproliferative disorder was detected. Based on these findings, a diagnosis of eosinophilic myocarditis due to Churg-Strauss syndrome was considered. She was administered prednisolone at a dose of 1 mg/kg, cyclophosphamide, and diuretics. Several markers of eosinophilic myocarditis and heart failure gradually improved, including ECP. She was discharged 30 days later with no cardiac event. Eosinophilic myocarditis is characterized by predominantly eosinophilic infi ltration. Eosinophilic granule proteins, such as ECP and major basic protein, play important roles in the pathogenesis of eosinophilic myocarditis. We experienced a rare case of eosinophilic myocarditis due to Churg-Strauss syndrome. Markedly elevated ECP played an important role in the early diagnosis and subsequent reduction in ECP served as a marker of monitoring. In an asthmatic patient with dyspnea, hypereosinophilia, and vasculitis, Churg-Strauss syndrome with eosinophilic myocarditis should be considered.
著者
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Ise Takayuki
Department of Medicine and Bioregulatory Sciences, Institute of Health Biosciences, The University o
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Soeki Takeshi
Department of Biochemistry, National Cardiovascular Center Research Institute
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Sata Masataka
Department Of Advanced Clinical Science And Therapeutics Graduate School Of Medicine University Of T
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Yamada Hirotsugu
Department Of Cardiovascular Medicine Institute Of Health Bioscience Research The University Of Toku
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Ueda Yuka
Department Of Pediatrics Kinki University School Of Medicine
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Niki Toshiyuki
Department Of Cardiovascular Medicine Institute Of Health Biosciences The University Of Tokushima Gr
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Tomita Noriko
Department Of Cardiovascular Medicine Institute Of Health Biosciences The University Of Tokushima Gr
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Wakatsuki Tetsuzo
Department Of Cardiovascular Medicine Institute Of Health Biosciences The University Of Tokushima Gr
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Iwase Takashi
Department Of Cardiovascular Medicine The University Of Tokushima Graduate School Of Health Bioscien
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Yamaguchi Koji
Department Of Anesthesiology Nagasaki University School Of Medicine
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Taketani Yoshio
Department Of Cardiology And Clinical Research National Hospital Organization Zentsuji Hospital
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Bando Sachiko
Department of Cardiovascular Medicine, Tokushima University
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Wakatsuki Tetsuzo
Department of Cardiovascular Medicine, Institute of Health Biosciences, The University of Tokushima Graduate School
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Hara Tomoya
Department of Cardiovascular Medicine, Institute of Health Biosciences, The University of Tokushima Graduate School
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Kadota Muneyuki
Department of Cardiovascular Medicine, Institute of Health Biosciences, The University of Tokushima Graduate School
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Bando Mika
Department of Cardiovascular Medicine, Institute of Health Biosciences, The University of Tokushima Graduate School
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Ogasawara Kozue
Department of Cardiovascular Medicine, Institute of Health Biosciences, The University of Tokushima Graduate School
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Iwase Takashi
Department of Cardiovascular Medicine, Institute of Health Biosciences, The University of Tokushima Graduate School
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Niki Toshiyuki
Department of Cardiovascular Medicine, Institute of Health Biosciences, The University of Tokushima Graduate School
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Yamada Hirotsugu
Department of Cardiovascular Medicine, Institute of Health Biosciences, The University of Tokushima Graduate School
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Ise Takayuki
Department of Cardiovascular Medicine, Institute of Health Biosciences, The University of Tokushima Graduate School
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