Acute Eosinophilic Myocarditis and Heart Failure As the First Manifestation of Eosinophilic Granulomatosis With Polyangiitis (EGPA) in an Asthmatic Patient: A Diagnostic Challenge.

Eosinophilic granulomatosis with polyangiitis (EGPA) is a rare necrotizing vasculitis that affects multiple organ systems. Asthma is a hallmark clinical feature of the syndrome. Cardiac involvement is uncommon but constitutes one of the most severe and potentially life-threatening manifestations of the disease. We present a challenging diagnostic case of a 68-year-old woman with a history of asthma who presented with features suggestive of acute coronary syndrome and elevated cardiac troponin levels. Coronary angiography revealed only mild atheroma. The combination of a negative angiogram, marked eosinophilia, significantly elevated troponin, and cardiac dysfunction on imaging led to the diagnosis of EGPA-associated myocarditis. In this case, the disease initially manifested with cardiac symptoms, followed by subsequent renal impairment. Corticosteroid and immunosuppressive therapy effectively and rapidly controls disease activity. A multidisciplinary approach is essential in achieving optimal patient outcomes.