Lamparter S, Pankuweit S, Kölsch S, Maisch B. Komplizierter Verlauf eines Churg-Strauss-Syndroms mit eosinophiler Perimyokarditis und Perikard-Tamponade.
Dtsch Med Wochenschr 2004;
129:2173-6. [PMID:
15457397 DOI:
10.1055/s-2004-831861]
[Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
HISTORY
A 30-year-old patient suffered from a dry cough and increasing dyspnea since two years; he further complained about non radiating chest pain and weight loss of 15 kg in the past 8 weeks.
EXAMINATIONS
Physical examination revealed pulsus paradoxus and distended neck veins. On chest x-ray, signs of cardiomegaly without infiltrations were found. Echocardiographic studies demonstrated a large pericardial effusion with signs of pericardial tamponade. Pericardiocentesis and pericardioscopy was performed and pericardial as well as epimyocardial biopsy samples were taken. Serum studies revealed increased markers of myocardial infarction and hypereosinophilia without clinical evidence of parasitic, myeloproliferative, or neoplastic diseases. Diagnosis of acute eosinophilic myocarditis was established in the epimyocardial biopsy samples.
DIAGNOSIS, TREATMENT AND COURSE
Based on the clinicopathologic findings, we diagnosed Churg Strauss syndrome with cardiac involvement. We instilled 500 mg triamcinolone intrapericardially and initiated systemic treatment with corticosteroids which resulted in normalization of the blood eosinophil count. During a follow up of 18 months, no recurrence of pericardial effusion was detected. However, while trying to reduce the steroids below 15 mg prednisolone equivalent per day, eosinophil numbers raised and wheezing increased. We suggested an immunosuppressive therapy including cyclophosphamide according to the Fauci protocol, which was denied by the patient due to potential adverse side effects.
CONCLUSION
We suggest a detailed invasive strategy including endomyocardial biopsy to rule out viral myocarditis before immunosuppressive therapy with steroids is initiated in patients with suspected cardiac involvement in Churg Strauss syndrome.
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