RESUMO
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.
Assuntos
Asma , Bloqueio Atrioventricular , Síndrome de Churg-Strauss , Granulomatose com Poliangiite , Parada Cardíaca , Feminino , Humanos , Adulto , Pessoa de Meia-Idade , Síndrome de Churg-Strauss/complicações , Síndrome de Churg-Strauss/diagnóstico , Síndrome de Churg-Strauss/tratamento farmacológico , Granulomatose com Poliangiite/complicações , Granulomatose com Poliangiite/diagnóstico , Granulomatose com Poliangiite/tratamento farmacológico , Imunoglobulinas Intravenosas/uso terapêutico , Bloqueio Atrioventricular/diagnóstico , Bloqueio Atrioventricular/etiologia , Bloqueio Atrioventricular/terapia , Prednisolona/uso terapêutico , Ciclofosfamida/uso terapêutico , Asma/tratamento farmacológico , Parada Cardíaca/tratamento farmacológicoAssuntos
Corpo Caloso/patologia , Infecções por Vírus Epstein-Barr/tratamento farmacológico , Leucoencefalopatias/tratamento farmacológico , Linfo-Histiocitose Hemofagocítica/tratamento farmacológico , Corpo Caloso/efeitos dos fármacos , Ciclosporina/uso terapêutico , Dexametasona/uso terapêutico , Infecções por Vírus Epstein-Barr/complicações , Infecções por Vírus Epstein-Barr/diagnóstico , Etoposídeo/uso terapêutico , Feminino , Humanos , Leucoencefalopatias/diagnóstico , Leucoencefalopatias/etiologia , Linfo-Histiocitose Hemofagocítica/diagnóstico , Linfo-Histiocitose Hemofagocítica/etiologia , Linfo-Histiocitose Hemofagocítica/patologia , Metilprednisolona/uso terapêutico , Adulto JovemRESUMO
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.