Coronary Vasospasm in Eosinophilic Granulomatosis With Polyangiitis Presenting as Acute Coronary Syndrome Treated With Anti-IL-5.

backgroundEosinophilic granulomatosis with polyangiitis (EGPA) is a rare vasculitis that may involve the coronary arteries, even in ANCA-negative cases. CASE SUMMARY: A 58-year-old woman with a history of asthma, eosinophilia, and prior percutaneous coronary interventions presented with exertional dyspnea and chest tingling. Electrocardiogram showed transient anterior ST-segment elevations. Coronary angiography revealed multivessel coronary vasospasm with 100% occlusion of the mid left anterior descending artery, reversible with intracoronary nitroglycerin. Laboratory work-up confirmed ANCA-negative EGPA. The patient was initially treated with steroids and vasodilators, then transitioned to benralizumab owing to disease recurrence and steroid dependence. Her symptoms resolved, and eosinophil counts remained suppressed. DISCUSSION: Cardiac involvement in EGPA is uncommon but potentially fatal. This case highlights the importance of considering EGPA in recurrent acute coronary syndrome with eosinophilia and demonstrates the successful use of IL-5-targeted biologic therapy. TAKE-HOME MESSAGES: EGPA should be considered in recurrent acute coronary syndrome with eosinophilia. Benralizumab offers a steroid-sparing strategy in cardiac EGPA.