The role of endomyocardial biopsy in the diagnosis and treatment of Churg-Strauss syndrome

Churg-Strauss syndrome (CSS) is a rare vasculitis characterized by the clin ical triad of asthma, peripheral eosinophilia, and systemic vasculitis. Pul monary symptoms occur commonly, but gastrointestinal, renal, cardiac, and m usculoskeletal manifestations may also occur. Disease activity and expressi on can be variable, and progressive organ failure may occur in the absence of other clinical or biochemical evidence of disease activity. We report th e case of a 73-year-old man-who presented with signs and symptoms of an acu te myocardial infarction, eosinophilia, a pulmonary infiltrate, and recent onset asthma. The cardiac catheterization was normal, but act endomyocardia l biopsy specimen revealed eosinophilic myositis, granuloma formation, and small vessel vasculitis. A repeat endomyocardial biopsy 1 month after the i nitiation of high dose prednisone therapy showed no evidence of inflammatio n and no significant fibrosis. We suggest that a endomyocardial biopsy is a safe and useful tool in the diagnosis and monitoring of therapy in patient s with CSS cardiac disease.