title: ANCA-negative eosinophilic granulomatosis with polyangitis (EGPA) manifesting as a large intracardiac thrombus and glomerulonephritis with angionecrosis.
abstract: A 59-year-old woman with a history of bronchial asthma presented with a prolonged fever and eosinophilia. There was transient proteinuria and troponin level was elevated. Antineutrophil cytoplasmic antibody was negative and she did not fulfil criteria for eosinophilic granulomatosis with polyangitis (EGPA). Echocardiography showed a large apical mass in the left ventricle, but there was no systolic dysfunction, local asynergy or ventricular remodelling. On MRI, apical mass was compatible with a thrombus and endocardial region was diffusely damaged. Loeffler endocarditis-like cardiac manifestation led to meticulous examination, which found no aetiology for eosinophilia. Finally, renal biopsy revealed eosinophil infiltration and glomerular angionecrosis, confirming as EGPA. This case highlights the isolated large cardiac thrombus as a rare presenting sign for EGPA and underscores current complicated strategy to diagnose EGPA. Of note, this clinical challenge was mostly caused by inchoate comprehension of hypereosinophilia-related disorders.
authors: Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan.
authors: Yuichi
authors: Y
authors: Saito
authors: Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan.
authors: Sho
authors: S
authors: Okada
authors: Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan.
authors: Nobusada
authors: N
authors: Funabashi
authors: Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan.
authors: Yoshio
authors: Y
authors: Kobayashi
mesh_terms: D019268:Antibodies, Antineutrophil Cytoplasmic / Q000097:blood; D001808:Blood Vessels / Q000473:pathology; D015267:Churg-Strauss Syndrome / Q000097:blood / Q000150:complications*; D005260:Female; D005921:Glomerulonephritis / Q000209:etiology*; D014890:Granulomatosis with Polyangiitis / Q000097:blood / Q000150:complications*; D006331:Heart Diseases / Q000209:etiology*; D006801:Humans; D007668:Kidney / Q000098:blood supply / Q000473:pathology; D008875:Middle Aged; D009336:Necrosis / Q000209:etiology; D013927:Thrombosis / Q000209:etiology*
chemical_list: D019268:Antibodies, Antineutrophil Cytoplasmic