S3936 Beyond the Airways: Colonoscopic Clues to Systemic EGPA and Cardiac Salvage

Introduction: Eosinophilic granulomatosis with polyangiitis (EGPA) is a rare, multi-organ system vasculitis characterized by peripheral eosinophilia, chronic rhinosinusitis with nasal polyps, asthma and peripheral neuropathy. However, seronegative disease (ANCA negative) can include cardiomyopathy and GI manifestations. We report a case of a 53-year-old woman hospitalized for cardiogenic shock and offered a heart transplant, which ultimately was cancelled and listed UNOS status 7 due to acute diarrhea. Colonoscopy biopsies demonstrated significant eosinophilia. The patient was ultimately diagnosed with EGPA and heart transplant was deferred. Case Description/Methods: A 53-year-old woman who had history of allergies, allergic rhinitis, chronic obstructive pulmonary disease, non-ischemic cardiomyopathy with ejection fraction of 20%-25%, was hospitalized for cardiogenic shock. She was offered a heart transplant but was changed to UNOS status 7 due to acute diarrhea. Patient reported a single day of diarrhea with 4 liquid, brown bowel movements while hospitalized and denied any abdominal pain, nausea, vomiting, fever, chills, hematochezia or melena. Due to acute diarrhea, computed tomography abdomen/pelvis was performed concerning for severe colitis of cecum and ascending colon. GI was consulted and colonoscopy was performed that demonstrated area of significant congested circumferential mucosa with areas of hypopigmentation in ascending colon, and localized area of moderately friable and erythematous mucosa in cecum. Pathology demonstrated colonic mucosa with increased eosinophils with ischemic colitis. Additionally, patient underwent bone marrow biopsy demonstrating hyper eosinophilic syndrome. She was ultimately diagnosed with EGPA and started on intravenous steroids and cyclophosphamide. Discussion: EGPA is a rare form of vasculitis that can present with multi-system organ involvement that can include GI symptoms. Our patient had multisystem manifestations but presented with cardiogenic shock. Acute diarrhea while hospitalized prompted inpatient colonoscopy which resulted in colonic eosinophilia. Rheumatology confirmed diagnosis of EGPA and patient treated with IV steroids and cyclophosphamide. Ultimately, patient did not receive a heart transplant to this date. This case highlights the importance of early recognition of GI manifestations in vasculitis diseases such as EGPA and particularly prompt diagnosis can significantly affect patient outcomes, such as a life changing heart transplantation.