Multiple brain infarctions and endomyocarditis in ANCA-negative eosinophilic granulomatosis with polyangiitis

Figure 1. (A, B) Magnetic resonance imaging (MRI) upon admission. Diffusion-weighted MRI showed multiple infarctions in bilateral cerebrum and right cerebellum. (C) Transthoracic echocardiographic view. The high echogenicity of the endocardium in the interventricular septum and left ventricular inferior wall corresponded to areas of fibrosis (arrow). (D) The left ventricular global longitudinal strain was impaired in the interventricular septum and left ventricular inferior wall. (E) Cardiac MRI showed delayed enhancement in the interventricular septum and inferior endocardium (arrowheads). (F) Skin biopsy with hematoxylin and eosin staining revealed leukocytoclastic vasculitis accompanied by eosinophilic infiltration of the small vessels.

图1。(A、B) 为入院时的磁共振成像（Magnetic resonance imaging, MRI）。扩散加权MRI显示双侧大脑及右侧小脑多发梗死灶。(C) 经胸超声心动图切面：室间隔与左心室下壁的心内膜回声增强，对应纤维化区域（箭头所示）。(D) 左心室整体纵向应变在室间隔与左心室下壁处受损。(E) 心脏MRI显示室间隔与下壁心内膜存在延迟强化征象（箭头所示）。(F) 皮肤活检标本经苏木精-伊红（hematoxylin and eosin）染色后，镜下可见白细胞碎裂性血管炎伴小血管嗜酸性粒细胞浸润。