Abstract

Dr, Aravind kumar. Second Year Post Graduate, Department of Medicine 2020 Batch

Case Report:

ANTINEUTROPHIL CYTOPLAS MIC ANTIBODIE S – N EGATI VE EOSINOPHILIC
GRANULOMATOSIS WITH POLYANGITITS PRESENTINC AS SEVERE
CARDIOMYOPATHY.

A 49 year old female known case of Type 2 diabetes mellitus came with typical signs and symptoms
of heart failure – dyspnoea at rest associated with orthopnea and paroxysmal nocturnal dyspnoea,
bilateral lower limb swelling since 2 weeks. The patient also presented with signs and symptoms of
peripheral neuropathy- right foot drop with right lower limb sensory deficit. Complete blood count
showed Ieucocytosis- 23300 cells/cumm with hypereosinophilia (60.8%). Absolute eosinophil count
was 10560 cellsicumm. ESR- 90mm at one hour. CRP of 1.2gldl.2D Echo showed global
hypokinesia of the LV with severe LV dysfunction EF 20%. Nerve conduction study showed b/l
lower limb sensory and motor axonal and demyelinating neuropathy. Nerve biopsy of right sural
nerve showed necrotizing small vessel eosinophilic vasculitis suggestive of Churg Strauss syndrome
aisociated vasculitis. C and P ANCA were negative. Patient was started on steroid therapy with other
supplementary heart failure medications. Patient underwent Cardiac Stress Myocardial Perfusion
Imaging which showed dilated left ventricular cavity with severe hypokinesia of left ventricle
myocardium. Coronary angiography revealed normal coronaries. On subsequent follow up patient
improved symptomatically with review echocardiography showing ejection fraction of 40%.