Response by Alexander et al to Letters Regarding Article, “A Shocking Development in a Young Male Athlete With Chest Pain”

In Response:

We thank Dr McGorrian and colleagues for their insights on our challenging case recently presented in Circulation.¹ Eosinophilic coronary periarteritis is an intriguing potential cause of our patient’s presentation. As the authors describe, the disease entity has been characterized in patients with coronary artery vasospasm and associated coronary dissection or sudden cardiac death. As in our case, some may have a preexisting history of atopy. The most distinguishing features of eosinophilic coronary periarteritis are appreciated by histology, which reveals eosinophilic infiltration isolated to the adventitia and vasa vasorum of the epicardial coronary arteries.² Thus, this diagnosis is difficult to confirm outside of autopsy.

Some features of our case make eosinophilic coronary periarteritis less likely to be the main contributor to his presentation. On coronary angiography, there was no evidence of aneurysmal changes, which …