biostudies-literatureZhongkai WMedical leading Talents Training Program of Yunnan Provincial Health CommissionMajor Project of Yunnan University Medical Research Fund890https://www.ebi.ac.uk/biostudies/studies/S-EPMC12752052biostudies-literatureUnknown25(1)<h4>Background</h4>Eosinophilic granulomatosis with polyangiitis (EGPA) typically presents with asthma, but we report an anti-neutrophil cytoplasmic antibody (ANCA)-positive EGPA case with an unusual presentation: isolated abdominal pain as the initial manifestation of systemic vasculitis, which progressed rapidly to life-threatening cardiac involvement in the absence of overt respiratory symptoms at onset.<h4>Case presentation</h4>A 70-year-old female presented with abdominal pain and was found to have eosinophilia with elevated cardiac biomarkers. Despite normal coronary angiography, cardiac magnetic resonance revealed left ventricular hypoperfusion and an apical thrombus, leading to a diagnosis of eosinophilic myocarditis and vasculitis by biopsy. Symptoms and thrombus resolved with gluBMC cardiovascular disordersAbdominal pain as the sole initial manifestation of ANCA-positive EGPA with myocarditis: a case report and literature review.PMC12752052YDYXJJ2024-0001L-2019026Ruijie LHuang SZhongkai WChangyong WLiping LYunzhu PfalseAbdominal pain as the sole initial manifestation of ANCA-positive EGPA with myocarditis: a case report and literature review.<h4>Background</h4>Eosinophilic granulomatosis with polyangiitis (EGPA) typically presents with asthma, but we report an anti-neutrophil cytoplasmic antibody (ANCA)-positive EGPA case with an unusual presentation: isolated abdominal pain as the initial manifestation of systemic vasculitis, which progressed rapidly to life-threatening cardiac involvement in the absence of overt respiratory symptoms at onset.<h4>Case presentation</h4>A 70-year-old female presented with abdominal pain and was found to have eosinophilia with elevated cardiac biomarkers. Despite normal coronary angiography, cardiac magnetic resonance revealed left ventricular hypoperfusion and an apical thrombus, leading to a diagnosis of eosinophilic myocarditis and vasculitis by biopsy. Symptoms and thrombus resolved with glu2025-01-01T00:00:00Z2025 Nov2026-06-06T06:05:53.503Z2026-05-27T03:11:59.647ZS-EPMC127520524129925410.1186/s12872-025-05380-6