EGPA presenting as sudden cardiac arrest: a case report and review of cardiac manifestations

Figures

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  Figure 1. Admission electrocardiogram. The tracing shows sinus tachycardia with third-degree (complete) atrioventricular block and concomitant parasystole, corresponding to the clinical presentation of recurrent Adams-Stokes syndrome.

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  Figure 2. Chest CT scan on the day of admission. Images demonstrate bronchiectasis accompanied by extensive exudative opacities in both lungs, consistent with pulmonary involvement of EGPA.

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  Figure 3. Transthoracic echocardiography on admission. The study reveals significant thickening of the left ventricular endocardium (arrow, max 4.08 mm), a characteristic finding suggestive of eosinophilic infiltration.

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  Figure 4. Immunophenotyping of the lymphohematopoietic system. Analysis shows an increased proportion of eosinophils (12.27% of nucleated cells) with normal granulocytic differentiation, supporting a reactive eosinophilia.

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  Figure 5. Bone marrow biopsy histopathology. The marrow is mildly hypocellular with preserved trilineage maturation and readily visible eosinophils, showing no evidence of a myeloproliferative neoplasm and supporting the diagnosis of reactive eosinophilia in EGPA.

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  Figure 6. Bronchoscopic immunohistochemical staining. Stains for Periodic acid–Schiff (PAS) and acid-fast bacilli are negative, helping to exclude fungal and mycobacterial infections.

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  Figure 7. Bronchoscopic pathology (biopsy from the right lower lobe basal segment). Lung tissue shows fibroconnective tissue hyperplasia, chronic inflammation with multinucleated giant cell reaction, and scattered foreign body material(arrow). These findings are consistent with eosinophilic granulomatous inflammation and vasculitis, characteristic of EGPA pulmonary involvement.

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  Figure 8. Follow-up electrocardiogram 24 hours after glucocorticoid therapy. The recording demonstrates restoration of sinus rhythm with incomplete right bundle branch block, indicating rapid improvement in cardiac conduction following immunosuppression.

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  Figure 9. Follow-up echocardiogram at 2 months. The study shows reduction in the thickness of the septal endocardium to 2.94 mm (arrow), indicating response to treatment.

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  Figure 10. Follow-up chest CT scan at 2 months. The image reveals significant resolution of the previously noted pulmonary exudates, correlating with clinical improvement after therapy.