Eosinophilic myocarditis as part of Churg-Strauss syndrome, a rare cause of left heart failure with pulmonary oedema

History: A 50-year-old woman was admitted because of marked dyspnoea at res t and signs of left heart failure with pulmonary oedema. 9 years ago, the d iagnostic constellation of bronchial asthma, polyneuropathy, pericardial ef fusion and eosinophilia had indicated Churg-Strauss syndrome. Since then sh e had remained symptom-free under maintenance doses of azathioprine (for 2 years) and gradually reduced doses of steroids. Investigations: Chest X-ray showed signs of pulmonary congestion and cardio megaly, echocardiography demonstrating enlargement of the left heart with m arked impairment of ventricular function, and both revealed pericardial eff usion. The electrocardiogram showed complete absence of R waves and ST elev ation in leads V1-V5. Coronary angiography excluded coronary artery disease . Myocardial biopsy contained signs of active but no longer acute myocardit is with eosinophilic tissue infiltration and microgranulomas. White blood c ell count was normal, but there was marked eosinophilia (39%). IgE was elev ated (601 klU/l). Diagnosis, treatment and course: In view of the good therapeutic effects 9 years ago, this relapse of Churg-Strauss syndrome with eosinophilic myocard itis was again treated with azathioprine and steroids. In addition, diureti cs, digitalis and ACE-inhibitors successfully treated the heart failure. In the course of treatment the signs of inflammation, including the eosinophi lia, regressed or became normal. Conclusion: After a 10-year remission without complication of a Churg-Strau ss syndrome the onset of cardiac signs is the decisive long-term prognostic factor.