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Peer-reviewedCC BY 4.0JACC Case Reports

Coronary Vasospasm in Eosinophilic Granulomatosis With Polyangiitis

  • Francesco Saverio Rea1
  • Debora Russo2
  • Concetta Mammone2
  • Alfredo Fede2
  • Mario Arieti2
  • Michele Romano2
  • Plinio Cirillo1
  • Giovanni Esposito1
  • Corrado Lettieri2
  1. 1Department of Advanced Biomedical Sciences, University of Naples “Federico II”, Naples, Italy
  2. 2Division of Cardiology, Carlo Poma Hospital, Mantua, Italy
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Abstract

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.

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Cite

BibTeXRIS
BibTeX
@article{rea2026coronary,
  title = {{Coronary Vasospasm in Eosinophilic Granulomatosis With Polyangiitis}},
  author = {Francesco Saverio Rea and Debora Russo and Concetta Mammone and Alfredo Fede and Mario Arieti and Michele Romano and Plinio Cirillo and Giovanni Esposito and Corrado Lettieri},
  journal = {JACC Case Reports},
  year = {2026},
  month = aug,
  doi = {10.1016/j.jaccas.2026.110012},
  url = {https://doi.org/10.1016/j.jaccas.2026.110012},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Coronary Vasospasm in Eosinophilic Granulomatosis With Polyangiitis
AU  - Francesco Saverio Rea
AU  - Debora Russo
AU  - Concetta Mammone
AU  - Alfredo Fede
AU  - Mario Arieti
AU  - Michele Romano
AU  - Plinio Cirillo
AU  - Giovanni Esposito
AU  - Corrado Lettieri
PY  - 2026
DA  - 2026/08/28
JO  - JACC Case Reports
DO  - 10.1016/j.jaccas.2026.110012
UR  - https://doi.org/10.1016/j.jaccas.2026.110012
AB  - 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.
SN  - 2666-0849
ER  -