Is it ACS or Churg-Strauss Syndrome?
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Churg-Strauss syndrome (CSS) is a rare vasculitic disorder characterized by chronic rhinosinusitis, asthma, and persistent eosinophilia. Although not a usual prominent initial presentation, cardiac involvement is a major cause of morbidity and mortality in patients with CSS.

Published in the American Journal of Emergency Medicine, the authors report a case of a patient who presented with chest pain and was subsequently diagnosed with CSS with biopsy-proven eosinophilic myopericarditis.

A 72-year-old man who presented to the emergency department with a history of intermittent chest pain, exertional dyspnea, and bilateral lower extremities edema for 1 week.

The patient was diagnosed with acute non–ST elevation myocardial infarction with congestive heart failure. The patient underwent urgent cardiac catheterization, which revealed triple-vessel disease with 60% narrowing of proximal left anterior descending coronary artery, 70% stenosis OM2 branch, 60% napkin ring lesion of right coronary artery.

The patient underwent coronary artery bypass graft at which time pericardial and right atrial biopsies were performed. Pathology revealed organizing fibrinous pericarditis with mixed lymphocytic, eosinophilic, and histiocytic (nongranulomatous) inflammation, patchy infiltration of eosinophil along with other inflammatory cells without evidence of vasculitis in myocardial tissue.

Given a high suspicion of CSS, he was treated with intravenous methylprednisolone and subsequent oral prednisone. His eosinophil count dropped down to normal level after steroid therapy.

Key takeaways:-
- Cardiac involvement is very common in CSS, and echocardiogram and/or cardiac magnetic resonance imaging are useful diagnostic tools.

- Presence of cardiac disease is a poor prognostic sign required more aggressive treatment.

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