title: Lesson of the month 1: Beware the atypical presentation: eosinophilic granulomatosis with polyangiitis presenting as acute coronary syndrome.
abstract: We describe the case of a 45-year-old woman presenting with troponin positive cardiac-sounding chest pain. An initial emergency angiogram demonstrated two vessel coronary disease, including a distal right coronary artery occlusion. No percutaneous coronary intervention was performed and the patient was treated medically. At re-presentation with further pain a few days later, coronary angiography demonstrated no significant coronary lesions. After consideration of other multisystem symptoms and raised eosinophil count, the patient was diagnosed with eosinophilic granulomatosis with polyangiitis (formerly known as Churg-Strauss syndrome) presenting with coronary arteritis. This case should remind physicians to be vigilant and to consider non-atherosclerotic causes of acute coronary syndrome presentation, which should not always result in a stent.
authors.affiliation: Papworth Hospital, Cambridge, UK juergen@schiefermueller.com.
authors.forename: Juergen
authors.initials: J
authors.lastname: Schiefermueller
authors.affiliation: University Hospital Southampton, Southampton, UK.
authors.forename: Bashir
authors.initials: B
authors.lastname: Alaour
authors.affiliation: University Hospital Southampton, Southampton, UK.
authors.forename: Alison
authors.initials: A
authors.lastname: Calver
authors.affiliation: University Hospital Southampton, Southampton, UK.
authors.forename: Nick
authors.initials: N
authors.lastname: Curzen
mesh_terms: D054058:Acute Coronary Syndrome; D015267:Churg-Strauss Syndrome; D017023:Coronary Angiography; D005260:Female; D014890:Granulomatosis with Polyangiitis; D006801:Humans; D008875:Middle Aged
keywords: Churg-Strauss syndrome; EGPA; eosinophilic granulomatosis with polyangiitis; vasculitis