Eosinophilic Granulomatosis With Polyangiitis Presenting as Isolated Coronary Vasculitis

Eosinophilic granulomatosis with polyangiitis (EGPA) is a systemic vasculitis that can have cardiac involvement. Isolated coronary vasculitis as the sole EGPA manifestation is rare. A 30-year-old man with asthma and rhinitis presented with recurrent chest pain from coronary vasospasm due to EGPA. Treatment included cyclophosphamide, prednisone, verapamil, and nitrates. At the 6-month follow-up, he was asymptomatic. Coronary vasospasm secondary to EGPA can be present in younger populations and will present with acute coronary syndrome. EGPA flares can be triggered by viral infections. EGPA vasculitis can present with coronary vasospasm as the sole presenting symptom in young patients. EGPA vasculitis should be considered in patients with elevated eosinophils who have recurrent acute coronary syndrome with coronary vasospasm, especially in those with vasospasm refractory to typical medical management and with known/suspected EGPA.