Abstract 9840: A Rare Etiology of Diffuse Coronary Aneurysms

Abstract

Case: A 50-year-old woman with a prior right carotid aneurysm repair presented for chest pain. An evaluation 13 years ago showed a normal echo and cardiac catheterization. Four years prior, an echo showed an enlarged left ventricle with ejection fraction 57% and mid-anterolateral and inferolateral wall hypokinesis. Coronary angiography showed diffuse aneurysms of all coronary arteries with a proximal stenosis of the LAD, followed by a giant coronary aneurysm (Figure 1). CT angiography revealed bilateral intercostal artery aneurysms and a mildly ectatic aorta. She underwent bypass of the LAD with the LIMA. Aortic biopsy revealed no aortitis and prior carotid aneurysm pathology showed plasmalymphocytic inflammation; labs showed hypereosinophilia and elevated inflammatory markers with other negative immunologic work-up. She was diagnosed with hypereosinophilic vasculitis without evidence of granulomatosis and started on immunosuppressants.Due to symptoms, she underwent coronary angiography. Her LAD was occluded ostially with distal flow via a patent LIMA (Figure 2). There was progression of her aneurysmal disease at her proximal right coronary artery. No intervention was recommended. Instead, to improve control of her vasculitis, a Janus kinase inhibitor will be started. Discussion: Hypereosinophilic vasculitis, a variant of eosinophilic granulomatosis with polyangiitis, affects small- and medium-sized arteries and is challenging to diagnose. This case highlights a rare cardiac complication that can occur with this condition. Cardiac involvement often manifests as heart failure, pericarditis, valvular insufficiency, or rarely, coronary aneurysms.