Shigeo Godo, H. Takagi, Kohei Komaru, J. Takahashi, S. Yasuda
{"title":"与嗜酸性粒细胞增多症相关的难治性多血管冠状动脉痉挛病例报告:一个细胞,一种疾病?","authors":"Shigeo Godo, H. Takagi, Kohei Komaru, J. Takahashi, S. Yasuda","doi":"10.1093/ehjcr/ytae247","DOIUrl":null,"url":null,"abstract":"\n \n \n Hypereosinophilic syndrome (HES) is characterized by moderate to severe eosinophilia, exclusion of neoplastic or secondary origins of eosinophilia, and systemic involvement with end-organ damage. Coronary arteries can be affected to cause vasospastic angina (VSA); however, the association of the two diseases is not well recognized.\n \n \n \n A 55-year-old woman who had a history of multiple allergic disease such as bronchial asthma and chronic sinusitis with nasal polyps was hospitalized due to attacks of chest pain at rest. During a spontaneous attack of chest pain, ECG revealed ST-segment elevation in the inferior leads and emergency coronary angiography showed focal spasms of the right and left anterior descending coronary arteries, both of which were relieved after intracoronary administration of nitroglycerin. She was diagnosed with VSA according to the Japanese Circulation Society guidelines. Despite conventional vasodilator therapies, her resting angina remained refractory. Laboratory findings were notable for moderate eosinophilia. A comprehensive evaluation to uncover the underlying cause of refractory VSA led to the diagnosis of HES, concomitant with eosinophilic pneumonia and eosinophilic chronic rhinosinusitis. Pericoronary inflammation by fat attenuation index (FAI) was increased in the proximal segment of the right coronary artery. Treatment was initiated with oral prednisolone at a starting dose of 30 mg/day. The response to treatment was rapid, with her symptoms disappearing and a regression of eosinophilia observed the following day.\n \n \n \n HES manifests with refractory VSA, and eosinophil-suppressing corticosteroid therapy proves effective in improving both conditions along with reduction of the pericoronary inflammation by FAI.\n","PeriodicalId":507701,"journal":{"name":"European Heart Journal - Case Reports","volume":null,"pages":null},"PeriodicalIF":0.0000,"publicationDate":"2024-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"A Case Report of Refractory Multivessel Coronary Spasm Associated with Hypereosinophilic Syndrome: One Cell, One Disease?\",\"authors\":\"Shigeo Godo, H. Takagi, Kohei Komaru, J. Takahashi, S. Yasuda\",\"doi\":\"10.1093/ehjcr/ytae247\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"\\n \\n \\n Hypereosinophilic syndrome (HES) is characterized by moderate to severe eosinophilia, exclusion of neoplastic or secondary origins of eosinophilia, and systemic involvement with end-organ damage. Coronary arteries can be affected to cause vasospastic angina (VSA); however, the association of the two diseases is not well recognized.\\n \\n \\n \\n A 55-year-old woman who had a history of multiple allergic disease such as bronchial asthma and chronic sinusitis with nasal polyps was hospitalized due to attacks of chest pain at rest. During a spontaneous attack of chest pain, ECG revealed ST-segment elevation in the inferior leads and emergency coronary angiography showed focal spasms of the right and left anterior descending coronary arteries, both of which were relieved after intracoronary administration of nitroglycerin. She was diagnosed with VSA according to the Japanese Circulation Society guidelines. Despite conventional vasodilator therapies, her resting angina remained refractory. Laboratory findings were notable for moderate eosinophilia. A comprehensive evaluation to uncover the underlying cause of refractory VSA led to the diagnosis of HES, concomitant with eosinophilic pneumonia and eosinophilic chronic rhinosinusitis. Pericoronary inflammation by fat attenuation index (FAI) was increased in the proximal segment of the right coronary artery. Treatment was initiated with oral prednisolone at a starting dose of 30 mg/day. The response to treatment was rapid, with her symptoms disappearing and a regression of eosinophilia observed the following day.\\n \\n \\n \\n HES manifests with refractory VSA, and eosinophil-suppressing corticosteroid therapy proves effective in improving both conditions along with reduction of the pericoronary inflammation by FAI.\\n\",\"PeriodicalId\":507701,\"journal\":{\"name\":\"European Heart Journal - Case Reports\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2024-05-15\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"European Heart Journal - Case Reports\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1093/ehjcr/ytae247\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"European Heart Journal - Case Reports","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1093/ehjcr/ytae247","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0
摘要
嗜酸性粒细胞过多综合征(HES)的特征是中度至重度嗜酸性粒细胞增多,排除嗜酸性粒细胞增多的肿瘤性或继发性来源,全身受累并伴有内脏损害。冠状动脉受累可引起血管痉挛性心绞痛(VSA);然而,这两种疾病的关联性尚未得到充分认识。 一名 55 岁的妇女曾患有多种过敏性疾病,如支气管哮喘和伴有鼻息肉的慢性鼻窦炎,因休息时胸痛发作而住院治疗。在一次自发性胸痛发作时,心电图显示下导联 ST 段抬高,急诊冠状动脉造影显示右冠状动脉和左前降支冠状动脉局灶性痉挛,冠状动脉内注射硝酸甘油后症状缓解。根据日本循环学会指南,她被诊断为 VSA。尽管使用了常规的血管扩张剂疗法,她的静息心绞痛仍然难治。实验室检查结果为中度嗜酸性粒细胞增多。为了找出难治性心绞痛的根本原因,医生对该患者进行了全面评估,最终确诊为 HES,同时伴有嗜酸性粒细胞肺炎和嗜酸性粒细胞慢性鼻炎。根据脂肪衰减指数(FAI),右冠状动脉近段的冠状动脉周围炎症加重。患者开始接受口服泼尼松龙治疗,起始剂量为 30 毫克/天。治疗反应很快,第二天她的症状就消失了,嗜酸性粒细胞也有所减少。 HES 表现为难治性 VSA,而抑制嗜酸性粒细胞的皮质类固醇治疗可有效改善这两种情况,同时通过 FAI 减少冠状动脉周围炎症。
A Case Report of Refractory Multivessel Coronary Spasm Associated with Hypereosinophilic Syndrome: One Cell, One Disease?
Hypereosinophilic syndrome (HES) is characterized by moderate to severe eosinophilia, exclusion of neoplastic or secondary origins of eosinophilia, and systemic involvement with end-organ damage. Coronary arteries can be affected to cause vasospastic angina (VSA); however, the association of the two diseases is not well recognized.
A 55-year-old woman who had a history of multiple allergic disease such as bronchial asthma and chronic sinusitis with nasal polyps was hospitalized due to attacks of chest pain at rest. During a spontaneous attack of chest pain, ECG revealed ST-segment elevation in the inferior leads and emergency coronary angiography showed focal spasms of the right and left anterior descending coronary arteries, both of which were relieved after intracoronary administration of nitroglycerin. She was diagnosed with VSA according to the Japanese Circulation Society guidelines. Despite conventional vasodilator therapies, her resting angina remained refractory. Laboratory findings were notable for moderate eosinophilia. A comprehensive evaluation to uncover the underlying cause of refractory VSA led to the diagnosis of HES, concomitant with eosinophilic pneumonia and eosinophilic chronic rhinosinusitis. Pericoronary inflammation by fat attenuation index (FAI) was increased in the proximal segment of the right coronary artery. Treatment was initiated with oral prednisolone at a starting dose of 30 mg/day. The response to treatment was rapid, with her symptoms disappearing and a regression of eosinophilia observed the following day.
HES manifests with refractory VSA, and eosinophil-suppressing corticosteroid therapy proves effective in improving both conditions along with reduction of the pericoronary inflammation by FAI.