Successfully treated eosinophilic granulomatosis with polyangiitis relapse presenting as myocarditis and followed by multimodality imaging

A 60-year-old man with eosinophilic granulomatosis with polyangiitis (EGPA), which was diagnosed 12 years earlier and managed with prednisolone, was admitted to our hospital because of dyspnea and paresthesias in both hands. Laboratory test revealed peripheral eosinophilia along with elevated troponin T and brain natriuretic peptide (BNP). The patient's clinical picture was consistent with myocarditis and relapse of EGPA. Endomyocardial biopsy showed marked infiltration of eosinophils in myocardium, which confirmed relapse of EGPA with myocarditis. Thallium-201 and iodine-123-beta-methyl iodophenyl pentadecanoic acid dual single-photon emission computed tomography (TL-BMIPP SPECT), as well as cardiac magnetic resonance imaging (CMR), also confirmed cardiac involvement. The patient was treated with methylprednisolone and improved dramatically. CMR and TL-BMIPP SPECT performed after discharge showed improvement of abnormal lesions, while anomalies detected by these modalities remained. This is a case of EGPA relapse presenting as myocarditis despite treatment with prednisolone. <Learning objective: Cardiac involvement and relapse are frequent in eosinophilic granulomatosis with polyangiitis patients. Patients should be screened and monitored carefully for cardiac involvement during follow-up by multimodality imaging.>.