Abstract
BACKGROUND: Eosinophilic granulomatosis with polyangiitis (EGPA) is a rare vasculitis; cardiac involvement is common and worsens prognosis. CASE SUMMARY: A 42-year-old man presented with chest pain, marked ST-T changes, eosinophilia, and elevated troponin, without obstructive coronary disease. He was diagnosed with acute eosinophilic endomyocarditis, mildly reduced left ventricular (LV) ejection fraction, and a large apical thrombus-an initial manifestation of probable EGPA. The patient received anticoagulation, corticosteroids, and immunosuppressive therapy. Endomyocardial fibrosis was confirmed via LV biopsy. During follow-up, electrocardiography and troponin T normalized, cardiac magnetic resonance (CMR) showed thrombus resolution, LV function recovery, and persistent subendocardial fibrosis. DISCUSSION: This case illustrates severe cardiac involvement in EGPA, with serial cardiac testing including striking electrocardiogram and CMR findings. TAKE-HOME MESSAGE: Cardiac involvement in EGPA is prevalent. Complete cardiac screening including CMR is advisable in all patients.