An unusual cause of myocardial infarction in an elderly man

ardiac involvement in eosinophilic granulomatosis with polyangiitis (EPGA) is increasingly recognized, but it is unusual to be the initial presentation.We report a case of vasculitic myocardial infarction (MI) and cardiogenic shock in an elderly man caused by EPGA.A 73-year-old man presented with acute chest pain radiating to back for two days.He has a history of asthma and allergic rhinitis for more than ten years well controlled by inhaled corticosteroid.The electrocardiogram showed sinus rhythm, right bundle-branch block and anterolateral ST-segment depression.He had elevated troponin T of 548 ng/L (reference: < 14 ng/L), creatine kinase of 454 IU/L (reference: 39-308 IU/L), white blood cell count of 13.8 × 10 9 /L (reference: 3.7-9.3× 10 9 /L) and eosinophil count of 12.4 × 10 9 /L (reference: 0.0-0.6 × 10 9 / L).Antineutrophil cytoplasmic, anti-extractable nuclear antigen, and anti-nuclear antibodies were negative.The evolution of laboratory parameters is shown (Figure 1).Transthoracic echocardiogram showed reduced left ventricular ejection fraction of 40%, anterolateral hypokinesia and 1 cm pericardial effusion near left ventricular apex.