Pathology cases — sudden death due to Churg-Strauss syndrome (eosinophilic granulomatosis)

This is a case of a woman in her 30s who had been increasingly ill for about two years, but with negative workups.  She then suffered a rapid decline and became short of breath.  She was prescribed steroids.  Her husband went out to get the prescription filled, and found her unresponsive upon return.   At autopsy, she was an emaciated young woman with palpable breast masses.  On external exam, I suspected metastatic breast cancer.  But, on internal examination, she had a number of brown masses in numerous organs, most prominently the breasts.  She had large areas of what appeared to be necrosis of the myocardium:

Here’s a low power of the heart:

Medium power:

And here’s higher power views:

And there was significant vasculitis:

Extensive lesions were found in the lungs:

And in the liver:

And the breasts:

I classified the cause of death as:

Acute fulminant eosinophilic myocarditis   Due to:

Hypereosinophilc syndrome Due to:

Eosinophilic granulomatosis with polyangiitis (Churg-Strauss syndrome)

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