ABSTRACT
Cardiac manifestations are the major cause of mortality in patients with eosinophilic granulomatosis with polyangiitis (EGPA). Among these manifestations in EGPA patients, in the literature, there are fewer reports describing bradycardia in EGPA patients than those describing tachycardia. A 50-year-old woman with a history of childhood-onset asthma. At age 28, she was diagnosed with eosinophilic gastroenteritis without the diagnosis of EGPA and was started on a systemic steroid and had maintenance daily dose of 2.5 mg after gradually tapered. She had experiencing dizziness and palpitations 2 weeks after discontinuation of the steroid treatment. At emergency visit, electrocardiography revealed an advanced atrioventricular block of 3:1 or less. Forty-eight minutes after the start of electrocardiography, only a P wave was observed and cardiac arrest occurred for 9 s and temporary emergency pacing was performed immediately. She was diagnosed as EGPA presenting leukocyte count, 16,500/µL, 42.8% of which were eosinophils and sinusitis in computed-tomography. She could be survival by treatment of steroid, following the patient to withdraw from an external pacemaker. She received prednisolone of 60 mg, intravenous cyclophosphamide and intravenous immunoglobulin. She had relapsed presenting peripheral eosinophilia, abdominal and numbness in the toes of the left leg pain, but not arrythmia after tapered of prednisolone. Following additional steroid pulse, she had an increase of prednisolone and continued by intravenous cyclophosphamide, intravenous immunoglobulin and started mepolizumab. We presented a severe case of EGPA presenting an advanced atrioventricular block into cardiac arrest.
Subject(s)
Asthma , Atrioventricular Block , Churg-Strauss Syndrome , Granulomatosis with Polyangiitis , Heart Arrest , Female , Humans , Adult , Middle Aged , Churg-Strauss Syndrome/complications , Churg-Strauss Syndrome/diagnosis , Churg-Strauss Syndrome/drug therapy , Granulomatosis with Polyangiitis/complications , Granulomatosis with Polyangiitis/diagnosis , Granulomatosis with Polyangiitis/drug therapy , Immunoglobulins, Intravenous/therapeutic use , Atrioventricular Block/diagnosis , Atrioventricular Block/etiology , Atrioventricular Block/therapy , Prednisolone/therapeutic use , Cyclophosphamide/therapeutic use , Asthma/drug therapy , Heart Arrest/drug therapySubject(s)
Corpus Callosum/pathology , Epstein-Barr Virus Infections/drug therapy , Leukoencephalopathies/drug therapy , Lymphohistiocytosis, Hemophagocytic/drug therapy , Corpus Callosum/drug effects , Cyclosporine/therapeutic use , Dexamethasone/therapeutic use , Epstein-Barr Virus Infections/complications , Epstein-Barr Virus Infections/diagnosis , Etoposide/therapeutic use , Female , Humans , Leukoencephalopathies/diagnosis , Leukoencephalopathies/etiology , Lymphohistiocytosis, Hemophagocytic/diagnosis , Lymphohistiocytosis, Hemophagocytic/etiology , Lymphohistiocytosis, Hemophagocytic/pathology , Methylprednisolone/therapeutic use , Young AdultABSTRACT
The successful preparation of TiO2-montmorillonite mesoporous composites using intercalation of titanium isopropoxide dissolved in supercritical carbon dioxide involved ion exchange of interlayer cations by hydrophobic cations.
