Churg-Strauss vasculitis presenting with steroid-responsive left ventricular cardiac mass

BMJ Case Rep. 2018 Oct 17:2018:bcr2018226052. doi: 10.1136/bcr-2018-226052.

Abstract

A 35-year-old black Saudi man, with a known case of bronchial asthma and allergic rhinitis since childhood, presented with joint pain and swelling, orthopnoea, paroxysmal nocturnal dyspnoea and lower extremity oedema. On examination, we found jugular venous distension, bilateral basal crepitation, wheezing and diffuse synovitis. Investigations were notable for peripheral blood eosinophilia, pericardial effusion and elongated structure in the left ventricular outflow tract on echocardiography, mediastinal and hilar lymphadenopathy and right upper lobe infiltrate on high-resolution CT scan. Pulmonary infiltrate biopsy confirmed eosinophilic vasculitis. Intracardiac mass resolved shortly after pulse steroids indicating an inflammatory mass.

Keywords: rheumatology; vasculitis.

Publication types

  • Case Reports

MeSH terms

  • Administration, Intravenous
  • Adult
  • Churg-Strauss Syndrome / diagnosis*
  • Churg-Strauss Syndrome / drug therapy
  • Churg-Strauss Syndrome / pathology
  • Diagnosis, Differential
  • Echocardiography / methods
  • Eosinophilia / blood
  • Glucocorticoids / therapeutic use
  • Heart Neoplasms / drug therapy*
  • Heart Neoplasms / pathology
  • Heart Ventricles / diagnostic imaging*
  • Heart Ventricles / pathology
  • Heart Ventricles / physiopathology
  • Humans
  • Lung / diagnostic imaging
  • Lung / drug effects
  • Lung / pathology*
  • Lymphadenopathy / pathology
  • Male
  • Mediastinum / pathology
  • Methylprednisolone / administration & dosage
  • Methylprednisolone / therapeutic use
  • Pericardial Effusion / diagnosis
  • Rare Diseases
  • Saudi Arabia / ethnology
  • Tomography, X-Ray Computed / methods
  • Treatment Outcome
  • Vasculitis / drug therapy*
  • Vasculitis / immunology

Substances

  • Glucocorticoids
  • Methylprednisolone