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

Eosinophilic granulomatosis with polyangiitis (EGPA) is a small vessel necrotizing vasculitis characterized by asthma and eosinophilia. Ischemic stroke is a rare complication of the disease. We herein report a case involving a 77-year-old woman with sinusitis who developed embolic stroke and splenic infarctions. Laboratory tests revealed hypereosinophilia and elevated troponin-T and N-terminal pro-brain natriuretic peptide. Antineutrophil cytoplasmic antibodies (ANCA) studies were negative. Skin biopsy showed infiltration of eosinophils into the arterial walls. These clinicopathological findings led to the diagnosis of EGPA. We also found the evidence of endomyocarditis as revealed by multimodality cardiac imaging. The patient underwent continuous immunosuppressive and anticoagulation therapy, and the infarctions did not recur. This report highlights the importance of histologically proven vasculitis with eosinophil infiltration and careful examination for cardiac involvement, especially in ANCA-negative patients.嗜酸性肉芽肿性多血管炎（Eosinophilic granulomatosis with polyangiitis，EGPA）是一种以哮喘与嗜酸性粒细胞增多为特征的小血管坏死性血管炎。缺血性脑卒中为该疾病的罕见并发症。本文报告1例77岁女性鼻窦炎患者，继发栓塞性脑卒中及脾梗死。实验室检查显示其存在高嗜酸性粒细胞血症，肌钙蛋白T及N末端B型利钠肽原水平升高。抗中性粒细胞胞浆抗体（Antineutrophil cytoplasmic antibodies，ANCA）检测结果为阴性。皮肤活检可见嗜酸性粒细胞浸润动脉管壁。结合上述临床病理表现，确诊为EGPA。此外，经多模态心脏成像检查，我们发现患者存在心内膜心肌炎证据。该患者接受持续免疫抑制与抗凝治疗后，梗死未再复发。本案例凸显了对伴嗜酸性粒细胞浸润的经组织学证实的血管炎进行诊断，并仔细排查心脏受累情况的重要性，尤其针对ANCA阴性患者。