Hypereosinophilic syndrome associated with multiple coronary aneurysms

Aneurysmal coronary artery disease occurring in the absence of stenotic atherosclerotic plaques is extremely rare and the pathophysiology of focal aneurysm formation is poorly understood. Whilst clinical-histological correlates exist linking spontaneous coronary artery dissection and perivascular eosinophilic infiltration in otherwise healthy individuals, the occurrence of aneurysms exclusively affecting the coronary tree in the setting of hypereosinophilic syndrome has not been previously reported. We describe the case of a 72-year-old woman presenting with cardiac chest pain in the context of recently diagnosed idiopathic hypereosinophilic syndrome with subsequent coronary angiography revealing multiple coronary aneurysms but only minor coronary atherosclerosis and no evidence of systemic arterial aneurysm formation. A brief review of the management strategies of patients with ectatic coronary artery disease is presented.