Copyright
©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
Eosinophilic granulomatosis with polyangiitis, asthma as the first symptom, and subsequent Loeffler endocarditis: A case report
Jia-Ling He, Xing-Yu Liu, Yi Zhang, Li Niu, Xin-Lin Li, Xing-Yu Xie, Yang-Ting Kang, Lan-Qing Yang, Zheng-Yang Cai, Hui Long, Guang-Fei Ye, Jun-Xin Zou
Jia-Ling He, Yi Zhang, Xing-Yu Xie, Yang-Ting Kang, Zheng-Yang Cai, Department of Emergency, Affiliated Hospital of Guizhou Medical University, Guiyang 550001, Guizhou Province, China
Xing-Yu Liu, Department of Orthopedic Surgery, Affiliated Hospital of Guizhou Medical University, Guiyang 550001, Guizhou Province, China
Li Niu, Department of Internal Cardiovascular Medicine, Affiliated Hospital of Guizhou Medical University, Guiyang 550001, Guizhou Province, China
Xin-Lin Li, Department of Medical Cosmetology, Beijing Puxiang Traditional Chinese Medicine Hospital, Beijing 100080, China
Lan-Qing Yang, College of Pediatrics, Guizhou Medical University, Guiyang 550001, Guizhou Province, China
Hui Long, Department of Internal Cardiovascular Medicine, People’s Hospital of Baiyun District, Guiyang 550014, Guizhou Province, China
Guang-Fei Ye, Department of Orthopedic Surgery, Hospital of Guizhou Panjiang Coal Power Group Limited Liability Company, Liupanshui 553537, Guizhou Province, China
Jun-Xin Zou, Department of Imaging, Affiliated Hospital of Guizhou Medical University, Guiyang 550001, Guizhou Province, China
Author contributions: He JL and Liu XY performed the data analyses and wrote the manuscript; Zhang Y, Niu L, Kang YT, and Yang LQ collected information and data from the patient; Cai ZY, Long H, Ye GF, and Zou JX analyzed the data and information; Li XL created the images; Xie XY reviewed and revised the manuscript; and all authors read and approved the final manuscript.
Supported by the 2020 National Natural Science Foundation Cultivation Project of Guizhou Medical University Affiliated Hospital, No. gyfynsfc[2020]-14.
Informed consent statement: Informed written consent was obtained from the patient for the publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Xing-Yu Xie, MD, Chief Physician, Department of Emergency, Affiliated Hospital of Guizhou Medical University, No. 28 Gui Medical Street, Guiyang 550001, Guizhou Province, China. 2524335567@qq.com
Received: May 17, 2023
Peer-review started: May 17, 2023
First decision: August 8, 2023
Revised: August 18, 2023
Accepted: September 1, 2023
Article in press: September 1, 2023
Published online: September 26, 2023
BACKGROUND
Eosinophilic granulomatosis with polyangiitis (EGPA), formerly known as Churg-Strauss syndrome, is a rare form of anti-neutrophil cytoplasmic antibody-associated vasculitis characterized by asthma, vasculitis, and eosinophilia.
CASE SUMMARY
We report an atypical case of EGPA in a 20-year-old female patient. Unlike previously reported cases of EGPA, this patient’s initial symptom was asthma associated with a respiratory infection. This was followed by Loeffler endocarditis and cardiac insufficiency. She received treatment with methylprednisolone sodium succinate, low molecular weight heparin, recombinant human brain natriuretic peptide, furosemide, cefoperazone sodium/sulbactam sodium, and acyclovir. Despite prophylactic anticoagulation, she developed a large right ventricular thrombus. EGPA diagnosis was confirmed based on ancillary test results and specialty consultations. Subsequent treatment included mycophenolate mofetil. Her overall condition improved significantly after treatment, as evidenced by decreased peripheral blood eosinophils and cardiac markers. She was discharged after 17 d. Her most recent follow-up showed normal peripheral blood eosinophil levels, restored cardiac function, and a reduced cardiac mural thrombus size.
CONCLUSION
This case illustrates the swift progression of EGPA and underscores the significance of early detection and immediate intervention to ensure a favorable prognosis.
Core Tip: Eosinophilic granulomatosis with polyangiitis (EGPA) is the rarest type of anti-neutrophil cytoplasmic antibody-associated vasculitis. The vast majority of patients present first with bronchial asthma and sinusitis, with a high risk of misdiagnosis. Clinicians should be alert to the possibility of EGPA when asthma and eosinophilia (> 10%) are found. Here, we report a 20-year-old female patient whose first symptom was asthma, followed by Loeffler endocarditis. She was finally diagnosed with EGPA, and after treatment with methylprednisolone sodium succinate, low molecular weight heparin, and mycophenolate mofetil, her condition improved and she was discharged. The patient’s condition was stable at follow-up.
