Successful Treatment with Mepolizumab for Coronary Spastic Angina Associated with Eosinophilic Granulomatosis with Polyangiitis

• Published in: Internal Medicine Vol. 62; no. 16; pp. 2389 - 2393
• Main Authors: Takigawa, Yuki, Fujiwara, Keiichi, Tabuchi, Isao, Kudo, Kenichiro, Hayashi, Kazuna, Matsumoto, Shoichiro, Omori, Hiroki, Matsuoka, Suzuka, Mitsumune, Sho, Watanabe, Hiromi, Sato, Akiko, Sato, Ken, Shibayama, Takuo
• Format: Journal Article
• Language: English
• Published: Tokyo The Japanese Society of Internal Medicine 15-08-2023; Japan Science and Technology Agency
• Subjects: Angina; Asthma; bronchial asthma; Case Report; Chest; coronary spastic angina; EGPA; eosinophilia; Granulomatosis; Internal medicine; Leukocytes (eosinophilic); mepolizumab; Pain; Prednisolone; Sinusitis
• ISSN: 0918-2918; 1349-7235
• DOI: 10.2169/internalmedicine.0930-22

A 46-year-old man with a history of bronchial asthma and chronic sinusitis presented to our hospital with chest pain. We suspected angina evoked by epicardial coronary spasm and performed an ergonovine provocation test to diagnose coronary spastic angina (CSA). The patient also met the diagnostic criteria for eosinophilic granulomatosis with polyangiitis (EGPA) and was treated with 60 mg prednisolone (PSL) for EGPA-associated CSA. After PSL administration, eosinophils decreased, and angina attacks disappeared. However, when PSL was tapered to 12.5 mg, chest pain recurred. We administered mepolizumab subcutaneously and chest pain disappeared. Additional mepolizumab may be effective for EGPA with CSA.