Coronary artery vasospasm in Churg-Strauss syndrome: BMJ cas
Patients with Churg-Strauss syndrome often suffer from unusual cardiac manifestations and sudden cardiac death. This differs from patients with other autoimmune disorders, who typically present with premature ischaemic heart disease.

The authors present the case of a 56-year-old man with recurrent coronary vasospasm, including an inferoposterior ST-elevation myocardial infarction, complicated by bradycardic arrest. There was only minor coronary artery disease on coronary angiography. An elevated eosinophil count was noted.

His medical history included allergic rhinitis with polyposis, adult-onset asthma and biopsy-proven eosinophilic oesophagitis. Review of his sinus biopsies demonstrated blood vessels with marked accumulation of eosinophils in extravascular areas.

The patient, therefore, met the American College of Rheumatology criteria for Churg-Strauss syndrome. The patient was commenced on immunosuppression, with the return of the eosinophil count to within normal limits, and remains free of cardiovascular events over 24 months.

Learning points
• Churg-Strauss syndrome (CSS) is associated with a number of unusual cardiac manifestations, including coronary vasospasm.

• These manifestations may be mediated by vasoactive compounds produced by eosinophils, which often infiltrate the heart.

• In patients presenting with cardiac pathology and eosinophilia, CSS should be considered in the differential diagnosis.

• Treatment with immunosuppression and resolution of eosinophilia may prevent further cardiovascular events.

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