JC44402

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1 J Cardiol 2004 Oct; 44 4 : Churg-Strauss : 1 Survivor of Cardiogenic Shock Following Acute Myocardial Infarction With Churg-Strauss Syndrome : First Angiographic Documention of Coronary Recanalization of Infarct-Related Arteries: A Case Report Takeyuki Junichi Michiaki Hidekazu Hiroshi Tetsuya Hisayuki Kenji Shinichiro Yosuke Teruhiko Masayuki Tetsushi Satoru Yuji Makoto Kamon Toshinobu KUBOTA, MD YAMAGUCHI, MD HIGASHITANI, MD MATSUSHIMA, MD SAKAMOTO, MD ISHIKAWA, MD OKADA, MD ENTA, MD TAKIZAWA, MD NAKANO, MD SUZUKI, MD MIZUNO, MD TSURUSAKI, MD ONODA, MD FUDA, MD MUTO, MD IMAI, MD, FJCC HORIE, MD, FJCC Abstract A 42-year-old man was treated under a diagnosis of Churg-Strauss syndrome with predonisolone pulse therapy. Three days later, he developed cardiogenic shock following acute myocardial infarction. Coronary angiography showed total occlusions in three peripheral coronary vessels. Intraaortic balloon pumping was used to maintain hemodynamics and predonisolone pulse therapy was repeated. However, he developed cardiogenic shock again after the second pulse therapy and needed percutaneous cardiopulmonary support and intraaortic balloon pumping. Accordingly, combination therapy of predonisolone and cyclophosphamide was given. He then recovered. Follow-up angiography showed recanalization of the infarct-related arteries. J Cardiol 2004 Oct; 44 4 : : Departments of Cardiology and Respiratory Medicine, Saitama Cardiovascular and Respiratory Center, Saitama Address for correspondence : KUBOTA T, MD, Department of Cardiology, Saitama Cardiovascular and Respiratory Center, Itai 1696, Konan-cho, Ohsato-gun, Saitama Manuscript received January 26, 2004 ; revised May 13, 2004 ; accepted May 13,

2 154 Key Words Complications Churg-Strauss syndrome Myocardial infarction, treatment Coronary artery disease Angiography Assisted circulation Interventional cardiology Churg-Strauss Churg-Strauss syndrome : CSS Churg Strauss 1,2 3 CSS 4 CSS intraaortic balloon pumping : IABP percutaneous cardiopulmonary support: PCPS CSS 3 42 : : : 20 /20 : : mg/day X 3 20 Table 1 CSS X CSS : 178cm68 kg 35.8 C140/min70/50mmHg Table 1 Laboratory data on admission March 20, 2003 Complete blood cell count WBC 8,400/ l Neu 50.50% Eo 27.30% Lym 18.10% Mono 3.80% Baso 0.30% RBC / l Hb 12.1 g/dl Ht 36.70% Plt / l MCV 84.9 MCH 27.9 MCHC 32.9 ESR 102 mm/hr Coagulation system Normal Urinalysis No abnormality Blood chemistry TP 8.2 g/dl Alb 3.9 g/dl T-Bil 0.5 g/dl AST 17 IU/l ALT 17 IU/l LDH 235 IU/l -GTP 27 IU/l CK 66 IU/l AMY 78 mg/dl BUN 6 mg/dl Cr 0.6 mg/dl Na 140 meq/l K 4.4 meq/l Cl 102 meq/l TC 200 mg/dl TG 76 mg/dl HDL-C 63 mg/dl CRP 7.5 mg/dl Immunological findings ANA Rheumatoid factor C3 101 C CH50 33 IgG 2,333 mg/dl IgA 361 mg/dl IgM 201 mg/dl IgE 213 mg/dl C-ANCA P-ANCA Arterial blood gas room air ph PO mmhg PCO mmhg BE 2.3 meq/l O 2 Sat 97.30% J Cardiol 2004 Oct; 44 4 :

Churg-Strauss 155 Fig. 1 Chest radiograph X : 55% Fig. 1 : a F QS 1 5 R 1 2 ST Fig. 2 : CK CK-MB AST LDHC C-reactive protein : CRP Table 2 Fig. 3 : 34% Killip American Heart Association Table 2 Fig.

431 PO 2 75.5 mmhg PCO 2 40.2 mmhg BE 2.3 meq/l O 2 Sat 97.30% Electrocardiogram Laboratory data just before transfer to the coronary care unit April 5, 2003 Blood chemistry TP 7.4 g/dl Alb 3.

3 Churg-Strauss 155 Fig. 1 Chest radiograph X : 55% Fig. 1 : a F QS 1 5 R 1 2 ST Fig. 2 : CK CK-MB AST LDHC C-reactive protein : CRP Table 2 Fig. 3 : 34% Killip American Heart Association Table 2 Fig. 2 Complete blood cell count WBC 15,000/ l Neu 85.5% Eo 0.2% Lym 8.1% Mono 6.00% Baso 0.20% RBC / l Hb 12.7 g/dl Ht 36.70% Plt / l Arterial blood gas face mask 10l ph PO mmhg PCO mmhg BE 2.3 meq/l O 2 Sat 97.30% Electrocardiogram Laboratory data just before transfer to the coronary care unit April 5, 2003 Blood chemistry TP 7.4 g/dl Alb 3.2 g/dl T-Bil 0.6 g/dl AST 150 IU/l ALT 34 IU/l LDH 1,402 IU/l -GTP 27 IU/l CK 1,391 IU/l AMY 78 mg/dl BUN 13 mg/dl Cr 0.7 mg/dl Na 136 meq/l K 4.6 meq/l Cl 97 meq/l CRP mg/dl J Cardiol 2004 Oct; 44 4 :

4 156 Fig. 3 Clinical course PSL predonisolone; WBC white blood cell; Eosino eosinophilic leucocyte; CRP C-reactive protein ; CAG coronary angiogram ; IABP intraaortic balloon pumping ; PCPS percutaneous cardiopulmonary support. : Figs. 4 A B D E IABP Fig. 3 IABP CRP Table 2 Fig IABP 21 a F 4 6 Q 36% IABP PCPS Fig mg/day 23 PCPS 27 IABP mg/day 79 CRP Fig. 3 X /20 mmhg 40 mmhg Figs. 4 C F 4 95 CRP 99 a F 4 6 Q J Cardiol 2004 Oct; 44 4 :

Churg-Strauss 157 Fig. 4 Coronary angiograms A, B: Left coronary artery B: higher magnification of white square in A on April 5, 2003.

5 Churg-Strauss 157 Fig. 4 Coronary angiograms A, B: Left coronary artery B: higher magnification of white square in A on April 5, Total occlusions of segments 8, 9 and 13 were observed white arrows. C: Left coronary artery on June 8, Improved coronary flow was observed blank arrows. D, E : Right coronary artery E : higher magnification of white square in D on April 5, Total occlusion of segment 4 atrioventricular node artery was observed white arrow. F : Right coronary artery on June 8, Improved coronary flow was observed blank arrow. 46% 142 CSS 1 2 T ,8 major basic protein eosinophil cationic protein 9,10 major basic protein eosinophil cationic protein 11 CSS CSS 12,13 J Cardiol 2004 Oct; 44 4 :

6 158 CRP CRP CRP CSS 4,14 IABP PCPS CSS CSS CSS IABP PCPS CRP CSS CSS 42 Churg-Strauss 3 2 Churg-Strauss J Cardiol 2004 Oct; 44 4 : Churg J, Strauss L : Allergic granulomatosis, allergic angiitis, and periarteritis nodosa. Am J Path 1951; 27 : : 1989; 78 : : 1999; 15 Suppl : Suzuki N, Arai Y, Miyamoto Y, Isokane N, Fukushima N, Sano : Acute myocardial injury and repeated angina pectoris-like attacks in a young patient with Churg-Strauss Syndrome. Jpn J Thorac Dis 1991; 29: J Cardiol 2004 Oct; 44 4 :

7 Churg-Strauss 159 5: Churg-Strauss 1999; 87 : : in ; pp : Churg- Strauss 1 Jpn Circ J 1999 ; 62 Suppl : 953 abstr 8 Kozak M, Gill EA, Green LS : The Churg-Strauss syndrome : A case report with angiographically documented coronary involvement and a review of the literature. Chest 1995; 107: : ; 35 : Egashira K, Tomoike H, Yamamoto Y, Yamada A, Hayashi Y, Nakamura M : Histamine-induced coronary spasm in regions of intimal thickening in miniature pigs: Roles of serum cholesterol and spontaneous or induced intimal thickening. Circulation 1986; 74 : Tai PC, Hayes DJ, Clark JB, Spry CJ : Toxic effects of human eosinophil products on isolated rat heart cells in vitro. Biochem J 1982; 204: : Churg-Strauss ; 51 : Libanoff AJ, McMahon NJ: Eosinophilia and endomyocardial fibrosis. Am J Cardiol 1976; 37: Shanks M, Ignaszewski AP, Chan SY, Allard MF : Churg- Strauss syndrome with myocarditis manifesting as acute myocardial infarction with cardiogenic shock : Case report and review of the literature. Can J Cardiol 2003 ; 19 : J Cardiol 2004 Oct; 44 4 :

/12/28 UP 3+, TP 4.2g/dl, Alb 1.9g/dl PSL 50mg/day 1/17 PSL 45mg/day PSL 2006/4/4 PSL 30mg/day mpsl mpsl1000mg 3 2 5/ :90 / :114/64 mmhg

17 2005/12/28 UP 3+, TP 4.2g/dl, Alb 1.9g/dl PSL 50mg/day 1/17 PSL 45mg/day PSL 2006/4/4 PSL 30mg/day mpsl mpsl1000mg 32 5/8 36.1 :90 /:114/64 mmhg 166.2 cm64.3 kg 3.9 g/dl 1.6 g/dl 382 mg/dl 408 mg/dl