Coronary Vasospasm in Eosinophilic Granulomatosis With Polyangiitis: A 4-Patient Case Series.

BACKGROUND: Coronary vasospasm is an uncommon manifestation of eosinophilic granulomatosis with polyangiitis (EGPA), and it may present as recurrent acute coronary syndrome (ACS). CASE SUMMARY: We report 4 patients presenting with recurrent ACS caused by angiographically documented coronary vasospasm. Three fulfilled the 2022 American College of Rheumatology/European Alliance of Associations for Rheumatology classification criteria for EGPA, whereas one was classified as having EGPA-like coronary inflammatory disease. Vasospastic episodes were refractory to conventional antianginal therapy but resolved rapidly after initiation of corticosteroids and immunosuppressive therapy. During a follow-up ranging from 2 to 6 years, no patient experienced recurrent cardiovascular events. DISCUSSION: Recurrent ACS in patients with asthma, eosinophilia, or allergic disease should raise suspicion of eosinophilic coronary inflammatory disease. Early recognition and prompt immunosuppressive therapy may prevent recurrent myocardial injury and improve long-term outcomes. TAKE-HOME MESSAGES: Coronary vasospasm may represent the first manifestation of EGPA or EGPA-like coronary inflammatory disease. In patients with recurrent ACS and coexisting asthma or eosinophilic disease, clinicians should maintain a high index of suspicion for eosinophilic coronary inflammation, as timely immunosuppressive therapy is essential for sustained disease control.