Key result
Benralizumab reduces cardiac magnetic resonance inflammatory activity at 6 months in EGPA myocarditis.
Why the study?
Eosinophilic myocarditis is a rare form of myocarditis that may be caused by eosinophilic granulomatosis with polyangiitis, which frequently affects the heart.
Case Report (n=1)
Eosinophilic myocarditis associated with EGPA can present initially as ischemic strokes and may be diagnosed via CMR and peripheral eosinophilia when biopsy is negative.
May support benralizumab in EGPA myocarditis when biopsy is negative; hypothesis-generating for prospective trials.
Background Eosinophilic myocarditis (EM) is a rare form of myocarditis which may be caused by eosinophilic granulomatosis with polyangiitis (EGPA), a rare disease which frequently affects the heart. The case of a young woman with a rare initial manifestation of EGPA as a cause of EM is reported. Case Summary A 39-year-old woman presented with diffuse neurological symptoms. She was diagnosed with multiple, bilateral, simultaneous ischemic strokes. No obvious stroke origin was detectable. However, significantly elevated troponin levels and eosinophilia were noted. Cardiac computed tomography ruled out coronary artery disease. Cardiac magnetic resonance imaging (CMR) proved myocarditis. However, endomyocardial biopsy (EMB), did not confirm EM. Nevertheless, EGPA with primary cardiac involvement was diagnosed due to eosinophilia, history of asthma, evidence of pANCA and matching CMR findings. Treatment with benralizumab was initiated. Follow-up CMR after about 6 months showed a significant reduction in inflammatory activity. Discussion EGPA and EM associated with EGPA are rare but in patients with EGPA, cardiac involvement is frequent. Ischemic strokes as an initial manifestation of EGPA is particularly rare. Other potential causes of stroke were ruled out. In the presence of CMR-proven myocarditis associated with peripheral eosinophilia, EM may be diagnosed without histological confirmation. EMB may be false negative in a relevant number of cases but CMR is usually abnormal. However, there are no specific CMR findings that occur exclusively in EM.
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Ley et al. (2026) conducted a case report in Eosinophilic granulomatosis with polyangiitis with eosinophilic myocarditis and ischemic strokes (n=1). Benralizumab was evaluated on Inflammatory activity on cardiac magnetic resonance imaging. Benralizumab treatment in a 39-year-old woman with eosinophilic granulomatosis with polyangiitis and eosinophilic myocarditis led to a significant reduction in inflammatory activity on cardiac magnetic resonance imaging at 6 months.
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