# Initial Hemorrhagic Pericardial Effusion Evolving Into Perimyocarditis: An Atypical Early Presentation of Eosinophilic Granulomatosis With Polyangiitis

## TL;DR

A young woman with a rare heart condition initially showed a large blood-filled fluid around the heart, later developing into perimyocarditis, highlighting an unusual early sign of EGPA.

## Contribution

This case report highlights the rare initial presentation of EGPA as hemorrhagic pericardial effusion evolving into perimyocarditis.

## Key findings

- EGPA can present with large hemorrhagic pericardial effusion, a rare and challenging initial manifestation.
- The disease progressed to perimyocarditis, indicating the progressive nature of EGPA.
- The case emphasizes the importance of considering EGPA in differential diagnoses of pericardial effusion.

## Abstract

Eosinophilic granulomatosis with polyangiitis (EGPA) is a form of multisystemic necrotizing vasculitis that has various manifestations. Cardiac involvement is one of the indications of poor prognosis, occurring with different reported prevalence. Due to the heterogeneity of EGPA presentation, its diagnosis relies on clinical condition supported by different investigations and classification criteria. However, large hemorrhagic pericardial effusion is a rare occurrence in EGPA, raising a diagnostic challenge with a wide differential diagnosis. EGPA can also affect other layers of the heart, making its development to perimyocarditis a warning for the progressive nature of the disease. We report a case of EGPA in a young female patient who presented initially with large hemorrhagic pericardial effusion, and later developed perimyocarditis.