Low-dose corticosteroid therapy improves refractory coronary vasospasm accompanied by eosinophilic granulomatosis with polyangiitis

A 57-year-old man was admitted to our hospital due to repeated chest pain. Coronary spastic angina was diagnosed by emergent coronary angiography. His chest attack was not suppressed with vasodilator therapy; however, it finally improved after administration of 20 mg prednisolone. His symptoms were controlled and elevation of the eosinophil count was normalized, even after tapering the dosage. His episodes of asthma, hypereosinophilia, mononeuropathy, and pulmonary infiltrate led to a diagnosis of eosinophilic granulomatosis with polyangiitis. <Learning objective: Coronary spastic angina (CSA) is rarely observed as cardiac involvement in patients with eosinophilic granulomatosis with polyangiitis (EGPA). Although previous reports have suggested that coronary vasospasm is resistant to standard therapy with vasodilator drugs, no appropriate treatment protocol has been established. This is the first case of CSA with EGPA successfully treated with a low-dose corticosteroid.>.