Eosinophilic vasculitis of aortic valve in EGPA: a life-threatening onset of disease.
Niccolò Paoletti, Leandro Cosco, Emanuele Vivarelli et al.
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Case in brief
A 51-year-old man with eosinophilic severe asthma and chronic rhinosinusitis presented with worsening dyspnea and cardiac arrest after two months of low-grade fever and malaise. He underwent surgery for acute torrential aortic regurgitation, revealing eosinophilic vasculitis of the aortic valve. Despite low blood eosinophils due to mepolizumab therapy, he was diagnosed with eosinophilic granulomatosis with polyangiitis (EGPA) and discharged with full recovery after treatment.
What made this case unusual
This case highlights a rare presentation of eosinophilic vasculitis affecting the aortic valve, which is not commonly reported in EGPA.
Diagnostic / clinical pearl
Clinicians should consider EGPA in patients with severe asthma and cardiac symptoms, even when eosinophil levels are low due to ongoing therapy.
Why it matters
This case underscores the need for careful monitoring and potential adjustment of mepolizumab dosage in patients with severe EGPA to prevent life-threatening complications.