A Case of Heart Failure Caused by Cardiac Involvement in Eosinophilic Granulomatosis with Polyangiitis

A 58-year-old woman presented with increasing shortness of breath and fatigue for three months. Her medical history revealed that she had started suffering from bronchial asthma and numbness in both legs about one year before admission. A chest x-ray showed pulmonary congestion and cardiomegaly. Transthoracic echocardiography demonstrated diffuse hypokinesis of the left ventricle with an ejection fraction of 38%. Intracardiac thrombi were detected in the left ventricular apex and left atrial appendage. Brain magnetic resonance imaging showed multiple cerebellar infarctions, but fortunately the lesions were asymptomatic. Laboratory examination revealed that B-type natriuretic peptide was elevated to 2700 pg/dL and eosinophils was elevated to 59.4%. Based on these findings, we diagnosed heart failure due to cardiac involvement of eosinophilic granulomatosis with polyangiitis (EGPA). In addition to standard heart failure therapy, oral prednisolone was introduced at a dose of 30 mg daily. Right ventricular myocardial biopsy was performed 7 days after steroid therapy. The pathological findings were compatible with post-myocarditic change, but without eosinophil infiltration. Although her heart failure symptoms were improved and left ventricular ejection fraction was increased to 51%, severe numbness and pain remained uncontrolled. Therefore, we decided to treat the patient with intravenous cyclophosphamide and high-dose intravenous immunoglobulin in addition to steroid therapy. We herewith report a case of heart failure associated with cardiac involvement in an EGPA patient.