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Prinzmetal's Angina Pectoris Revealing Aneurysm of the Right Coronary Artery During Evolution of Churg-Strauss Syndrome

1993; Elsevier BV; Volume: 103; Issue: 3 Linguagem: Inglês

10.1378/chest.103.3.978a

1931-3543

M Drogue, Jean‐Michel Vergnon, Bernard Wintzer, Jean‐Christophe Antoine, V. Malquarti,

Eosinophilic Disorders and Syndromes

Communications for this section will be published as space and priorities permit. The comments should not exceed 350 words in length, with a maximum of five references; one figure or table can be printed. Exceptions may occur under particular circumstances. Contributions may include comments on articles published in this periodical, or they may be reports of unique educational character. Specific permission to publish should be cited in a covering letter or appended as a postscript.To the Editor:We would like to report an interesting association in a recentChurg-Strauss syndrome was diagnosed in a 54-year-old woman after the successive occurrences over a six-year period of glucocorticoid-dependent asthma; eosinophilia, which peaked at 18,600/cu mm; and mononeuritis multiplex, confirmed by electromyogram and nerve biopsy (eosinophilic infiltrate without fibrinoid necrosis). In 1990 spontaneous hyperalgesic attacks of angina pectoris occurred, each lasting about 15 min. The percritical ECG showed the typical Prinzmetal findings of upward shifts of the ST segment and the J point. Coronary angiography showed a spindle-shaped aneurysm of the first and second segments of the right coronary artery, with a diameter double the normal size (Fig 1). The Methergine test reproduced both the chest pain and the percritical ST elevation. Aortic angiography showed an aneurysm of a middle-sized hepatic artery, which made it clear that this was a case of periarteritis nodosa,1Lahnam JC Elkon KB Pulsey CD Hughes C Systemic vasculitis with asthma and eosinophilia: a clinical approach to the Churg-Strauss syndrome.Medicine. 1984; 63: 65-79Crossref PubMed Scopus (1028) Google Scholar rather than Churg-Strauss syndrome.2Fauci AS Haynes BF Katz P The spectrum of vasculitis: clinical, pathology, immunology, and therapeutic considerations.Ann Intern Med. 1978; 89: 660-676Crossref PubMed Scopus (1009) Google ScholarCoronary aneurysm has been described previously in Kawasaki disease3Doi YL Hamashige N Odawara H Kuzume O Chikamori T Ozawa T Ring-calcification of coronary artery aneurysms in an adolescent.Chest. 1987; 92: 1118-1120Crossref PubMed Google Scholar and infantile polyarteritis nodosa.4Sinclair W Nitsch E Polyarteritis nodosa of the coronary arteries: report of a case in an infant with rupture of an aneurysm and intrapericardial hemorrhage.Am Heart J. 1949; 38: 898-904Abstract Full Text PDF PubMed Scopus (28) Google Scholar These vasculitides, artificially differentiated, are very similar. It seems logical to connect them with the coronary aneurysm with Prinzmetal's angina reported here. This finding has not, to our knowledge, been published previously. Communications for this section will be published as space and priorities permit. The comments should not exceed 350 words in length, with a maximum of five references; one figure or table can be printed. Exceptions may occur under particular circumstances. Contributions may include comments on articles published in this periodical, or they may be reports of unique educational character. Specific permission to publish should be cited in a covering letter or appended as a postscript. To the Editor: We would like to report an interesting association in a recent Churg-Strauss syndrome was diagnosed in a 54-year-old woman after the successive occurrences over a six-year period of glucocorticoid-dependent asthma; eosinophilia, which peaked at 18,600/cu mm; and mononeuritis multiplex, confirmed by electromyogram and nerve biopsy (eosinophilic infiltrate without fibrinoid necrosis). In 1990 spontaneous hyperalgesic attacks of angina pectoris occurred, each lasting about 15 min. The percritical ECG showed the typical Prinzmetal findings of upward shifts of the ST segment and the J point. Coronary angiography showed a spindle-shaped aneurysm of the first and second segments of the right coronary artery, with a diameter double the normal size (Fig 1). The Methergine test reproduced both the chest pain and the percritical ST elevation. Aortic angiography showed an aneurysm of a middle-sized hepatic artery, which made it clear that this was a case of periarteritis nodosa,1Lahnam JC Elkon KB Pulsey CD Hughes C Systemic vasculitis with asthma and eosinophilia: a clinical approach to the Churg-Strauss syndrome.Medicine. 1984; 63: 65-79Crossref PubMed Scopus (1028) Google Scholar rather than Churg-Strauss syndrome.2Fauci AS Haynes BF Katz P The spectrum of vasculitis: clinical, pathology, immunology, and therapeutic considerations.Ann Intern Med. 1978; 89: 660-676Crossref PubMed Scopus (1009) Google Scholar Coronary aneurysm has been described previously in Kawasaki disease3Doi YL Hamashige N Odawara H Kuzume O Chikamori T Ozawa T Ring-calcification of coronary artery aneurysms in an adolescent.Chest. 1987; 92: 1118-1120Crossref PubMed Google Scholar and infantile polyarteritis nodosa.4Sinclair W Nitsch E Polyarteritis nodosa of the coronary arteries: report of a case in an infant with rupture of an aneurysm and intrapericardial hemorrhage.Am Heart J. 1949; 38: 898-904Abstract Full Text PDF PubMed Scopus (28) Google Scholar These vasculitides, artificially differentiated, are very similar. It seems logical to connect them with the coronary aneurysm with Prinzmetal's angina reported here. This finding has not, to our knowledge, been published previously.