{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2023,3,8]],"date-time":"2023-03-08T09:34:55Z","timestamp":1678268095534},"reference-count":14,"publisher":"Georg Thieme Verlag KG","issue":"01","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pneumologie"],"published-print":{"date-parts":[[2021,1]]},"abstract":"<jats:title>Zusammenfassung<\/jats:title><jats:p>Ein 62-j\u00e4hriger Patient mit Asthma bronchiale und chronischer Rhinosinusitis unterzog sich einer Leistenhernien-OP. Nach der Operation kam es pl\u00f6tzlich zu einem reanimationspflichtigen Kreislaufstillstand. Koronarangiografisch zeigte sich eine 99\u200a%ige proximale RCA-Stenose bei ansonsten unauff\u00e4lligen und glattwandigen Koronarien. Im Verlauf kam es wiederholt zu \u00e4hnlichen Ereignissen, jetzt jedoch ohne Korrelat in der Koronarangiografie. Echokardiografisch zeigte sich initial eine LVEF von 45\u200a%. Es bestanden bipulmonale Infiltrate im R\u00f6ntgen-Thorax und eine schwere periphere Eosinophilie (37\u200a%). Die serologische Diagnostik inkl. ANA, ENA und c-\/p-ANCA blieb ohne Nachweis von Antik\u00f6rpern. Eine Knochenmarkspunktion zeigte keine Hinweise auf eine myeloproliferative Erkrankung. Der Patient klagte \u00fcber zunehmende Schw\u00e4che, Gewichtsverlust und Belastungsdyspnoe. Ein Methylprednisolon-Puls (250\u200amg\/Tag \u00fcber 3 Tage) zeigte keinen wesentlichen Effekt, sodass der Patient schlie\u00dflich bei zunehmender klinischer Verschlechterung in unsere Universit\u00e4tsklinik verlegt wurde. Bei \u00dcbernahme sahen wir einen abgeschlagenen Patienten mit progredienter Muskelatrophie und Belastungsdyspnoe. Klinisch zeigte sich eine rechtsseitige Peroneusparese. In der BAL zeigte sich eine schwere eosinophile Alveolitis (37\u200a%). Laborchemisch zeigten sich Herzenzyme und NT-proBNP stark erh\u00f6ht (Troponin-T\u200a&gt;\u200a700\u200ang\/l, NT-proBNP\u200a&gt;\u200a10,000\u200ang\/l). In der Echokardiografie fand sich eine dramatische Verschlechterung der Pumpfunktion (LVEF 16\u200a%). Eine interdisziplin\u00e4re Falldiskussion zwischen Kardiologen und Pneumologen war schlie\u00dflich der Schl\u00fcssel zur Diagnose einer ANCA-negativen eosinophilen Granulomatose mit Polyangiitis (EGPA) mit pulmonaler und kardialer Beteiligung. Nach Einleitung einer immunsuppressiven Therapie mit erneutem Methylprednisolon-Puls (1000\u200amg\/Tag \u00fcber 3 Tage) und anschlie\u00dfender Cyclophosphamid-Therapie (6 Pulse im 4-w\u00f6chigen Intervall) gestaltete sich der Verlauf erfreulich mit klinischer Beschwerdefreiheit, vollst\u00e4ndiger Regredienz der pulmonalen Infiltrationen und deutlicher Erholung der kardialen Pumpfunktion (LVEF 47\u200a%).<\/jats:p><jats:p>\n          Fazit\u2002ANCA-Positivit\u00e4t ist zur Diagnosestellung einer EGPA nicht erforderlich. Diese weisen nur 30\u200a\u2013\u200a70\u200a% der EGPA-Patienten auf, v.\u200aa. bei neurologischer und\/oder renaler, seltener bei pulmonaler und\/oder kardialer Beteiligung, was einen Fallstrick bei der Diagnosestellung darstellen kann. Die Induktionstherapie mit Cyclophosphamid stellt bei steroidrefrakt\u00e4rem Verlauf mit vital bedrohlicher Organbeteiligung die Therapie der Wahl dar.<\/jats:p>","DOI":"10.1055\/a-1209-4292","type":"journal-article","created":{"date-parts":[[2020,7,24]],"date-time":"2020-07-24T22:59:02Z","timestamp":1595631542000},"page":"33-38","source":"Crossref","is-referenced-by-count":1,"title":["Eosinophile Granulomatose mit Polyangiitis mit pulmonaler und kardialer Beteiligung"],"prefix":"10.1055","volume":"75","author":[{"given":"J. C.","family":"Kamp","sequence":"additional","affiliation":[{"name":"Klinik f\u00fcr Pneumologie, Medizinische Hochschule Hannover, Hannover"},{"name":"Biomedical Research in End-stage and Obstructive Lung Disease Hannover (BREATH), Deutsches Zentrum f\u00fcr Lungenforschung (DZL), Hannover"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"H.","family":"Suhling","sequence":"additional","affiliation":[{"name":"Klinik f\u00fcr Pneumologie, Medizinische Hochschule Hannover, Hannover"},{"name":"Biomedical Research in End-stage and Obstructive Lung Disease Hannover (BREATH), Deutsches Zentrum f\u00fcr Lungenforschung (DZL), Hannover"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M.","family":"Ramthor","sequence":"additional","affiliation":[{"name":"Klinik f\u00fcr Kardiologie und konservative Intensivmedizin, Vivantes Humboldt-Klinikum, Berlin"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J. B.","family":"Hinrichs","sequence":"additional","affiliation":[{"name":"Institut f\u00fcr diagnostische und interventionelle Radiologie, Medizinische Hochschule Hannover, Hannover"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"B.","family":"Soudah","sequence":"additional","affiliation":[{"name":"Institut f\u00fcr Pathologie, Medizinische Hochschule Hannover, Hannover"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J.","family":"Adel","sequence":"additional","affiliation":[{"name":"Klinik f\u00fcr Kardiologie und Angiologie, Medizinische Hochschule Hannover, Hannover"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"T.","family":"Welte","sequence":"additional","affiliation":[{"name":"Klinik f\u00fcr Pneumologie, Medizinische Hochschule Hannover, Hannover"},{"name":"Biomedical Research in End-stage and Obstructive Lung Disease Hannover (BREATH), Deutsches Zentrum f\u00fcr Lungenforschung (DZL), Hannover"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"F. 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