1
|
Shelton A, Parikh S, Mims C, Quintero-Del-Rio A. A challenging case of granulomatosis with polyangiitis with cardiac involvement: a rare case report. AME Case Rep 2022; 7:8. [PMID: 36817711 PMCID: PMC9929659 DOI: 10.21037/acr-22-29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 10/09/2022] [Indexed: 11/23/2022]
Abstract
Background Granulomatosis with polyangiitis (GPA), a systemic antineutrophil cytoplasmic antibody (ANCA) associated vasculitis, is characterized by inflammation of the small arteries, arterioles, and capillaries classically manifesting with glomerulonephritis and necrotizing granulomatous lesions of the upper and lower respiratory tract. With an incidence of approximately 12 cases per one million individuals per year it is an uncommon diagnosis that typically presents as frequent pulmonary and sinus infections; however, if left without definitive treatment progresses to more severe manifestations specifically hemoptysis and hematuria. Case Description This case report highlights a 15-year-old woman who had both classic and non-classic findings making the diagnosis challenging. Specifically, her age of presentation, improvement with anti-microbials, and coronary dilation were not classic. Additionally, her lab work was negative for the cytoplasmic subset antineutrophil cytoplasmic autoantibody (c-ANCA), but positive for serum anti-proteinase 3 antineutrophil cytoplasmic antibody (PR3-ANCA) which further delayed the ultimate diagnosis as this is typically c-ANCA positive. Conclusions Other systemic vasculitides, such as mucocutaneous lymph node disease, are associated with cardiac pathology necessitating further medical management and follow-up to prevent increased morbidity and mortality. Knowing this, we conclude that further evaluation for cardiac pathology would be prudent as part of the initial workup of patients with a diagnosis of GPA. Included is a brief review of available literature on GPA to emphasize the typical presentation, lab findings, and importance of early diagnosis.
Collapse
Affiliation(s)
- Anthony Shelton
- Department of Internal Medicine and Pediatrics, University of Oklahoma Children’s Hospital, The Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Suparshva Parikh
- Department of Internal Medicine and Pediatrics, University of Oklahoma Children’s Hospital, The Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Catherine Mims
- Department of Internal Medicine and Pediatrics, University of Oklahoma Children’s Hospital, The Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Ana Quintero-Del-Rio
- Department of Pediatric Rheumatology, University of Oklahoma Children’s Hospital, The Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| |
Collapse
|
2
|
Chevenon M, Robles N, Elizer S, Ellsworth E, Pophal S, Sabati A. Multiple Giant Coronary Artery Aneurysms in a Pediatric Patient with Granulomatosis with Polyangiitis. Pediatr Cardiol 2022; 43:1392-1395. [PMID: 35396672 PMCID: PMC8993586 DOI: 10.1007/s00246-022-02875-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 03/10/2022] [Indexed: 11/26/2022]
Abstract
Granulomatosis with polyangiitis (GPA) is characterized by necrotizing vasculitis of small and medium sized vessels and is rarely present in the pediatric population. Cardiac manifestations in pediatric patients with GPA are extremely uncommon, with only two known reported cases associated with coronary artery aneurysms (Rehani and Nelson in Pediatrics 147:e20200932, 2021, https://doi.org/10.1542/peds.2020-0932 ;Aghaei Moghadam et al. in Case Rep Cardiol 2020:3417910, 2020, https://doi.org/10.1155/2020/3417910 ). We report a case of a 14-year-old male who presented with a 1 month history of fatigue and shortness of breath. He ultimately was found to have multiple giant coronary aneurysms in both the left and right coronaries including a giant aneurysm in the posterior descending; this has not been previously reported. The case highlights the need for complete multi-modality imaging of the coronary arteries in patients with GPA.
Collapse
Affiliation(s)
- Marie Chevenon
- Division of Cardiology, Phoenix Children's Hospital, Phoenix, USA. .,The Heart Center, 1919 East Thomas Road, Phoenix, AZ, 85016, USA.
| | - Nicholas Robles
- grid.417276.10000 0001 0381 0779Division of Cardiology, Phoenix Children’s Hospital, Phoenix, USA
| | - Sydney Elizer
- grid.417276.10000 0001 0381 0779Division of Cardiology, Phoenix Children’s Hospital, Phoenix, USA
| | - Erik Ellsworth
- grid.417276.10000 0001 0381 0779Division of Cardiology, Phoenix Children’s Hospital, Phoenix, USA
| | - Stephen Pophal
- grid.417276.10000 0001 0381 0779Division of Cardiology, Phoenix Children’s Hospital, Phoenix, USA
| | - Arash Sabati
- grid.417276.10000 0001 0381 0779Division of Cardiology, Phoenix Children’s Hospital, Phoenix, USA
| |
Collapse
|
3
|
Koritala T, Mene-Afejuku TO, Schaefer M, Dondapati L, Pleshkova Y, Yasmin F, Mushtaq HA, Khedr A, Adhikari R, Al Mutair A, Alhumaid S, Rabaan AA, Al-Tawfiq JA, Jain NK, Khan SA, Kashyap R, Surani S. Granulomatous Polyangiitis With Renal Involvement: A Case Report and Review of Literature. Cureus 2021; 13:e19814. [PMID: 34963834 PMCID: PMC8695666 DOI: 10.7759/cureus.19814] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 11/22/2021] [Indexed: 12/02/2022] Open
Abstract
Granulomatosis with polyangiitis (GPA), formerly named Wegner’s granulomatosis is an antineutrophilic cytoplasmic antibody (ANCA) associated vasculitis of the small vessels. GPA can affect several organ systems even though predominantly affects respiratory and renal systems. Pathogenesis is initiated by activation of the immune system to produce ANCA, Cytoplasmic (C-ANCA) antibody, which thereby leads to widespread necrosis and granulomatous inflammation. Multisystem involvement with varied symptomatology makes GPA diagnosis more challenging. Early diagnosis and management are vital and can alter the prognosis of the disease. We present a literature review and a clinical scenario of a 26-year-old male with a history of chronic sinusitis, testicular carcinoma in remission, recent onset of worsening cough, epistaxis, hoarseness of voice, weight loss, and dark-colored urine. Workup revealed high titers of C-ANCA, C-reactive protein, procalcitonin, CT chest evidence of mass-like consolidation, and bronchoscopy findings of friable tissue that was not amenable for biopsy. Methylprednisolone and rituximab (RTX) were administered, which resulted in marked clinical improvement. Therefore, a keen eye for details is necessary to diagnose GPA early, which can improve disease outcomes dramatically.
Collapse
Affiliation(s)
| | | | | | - Lavanya Dondapati
- Internal Medicine, Dr. N.T.R University of Health Sciences, Vijayawada, IND
| | | | - Farah Yasmin
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
| | | | - Anwar Khedr
- Critical Care Medicine, Mayo Clinic, Mankato, USA.,Medicine, Tanta University Faculty of Medicine, Tanta, EGY
| | - Ramesh Adhikari
- Hospital Medicine, Franciscan Health, Lafayette, USA.,Geriatrics, Brown University, Providence, USA
| | - Abbas Al Mutair
- Emergency Medicine, Almoosa Specialist Hospital, Al-Ahsa, SAU
| | - Saad Alhumaid
- Pharmaceutical Care, Al-Ahsa Health Cluster, Al-Ahsa, SAU
| | - Ali A Rabaan
- Molecular Microbiology, Johns Hopkins Aramco Healthcare, Dhahran, SAU
| | | | | | | | - Rahul Kashyap
- Anesthesiology and Critical Care, Mayo Clinic, Rochester, USA
| | - Salim Surani
- Anesthesiology, Mayo Clinic, Rochester, USA.,Medicine, Texas A&M University, College Station, USA.,Medicine, University of North Texas Dallas, Dallas, USA.,Internal Medicine, Pulmonary Associates of Corpus Christi, Corpus Christi, USA.,Clinical Medicine, University of Houston, Houston, USA
| |
Collapse
|
4
|
Krittanawong C, Liu Y, Mahtta D, Narasimhan B, Wang Z, Jneid H, Tamis-Holland JE, Mahboob A, Baber U, Mehran R, Wilson Tang WH, Ballantyne CM, Virani SS. Non-traditional risk factors and the risk of myocardial infarction in the young in the US population-based cohort. IJC HEART & VASCULATURE 2020; 30:100634. [PMID: 32995474 PMCID: PMC7516292 DOI: 10.1016/j.ijcha.2020.100634] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 08/31/2020] [Accepted: 09/02/2020] [Indexed: 02/06/2023]
Abstract
Young patients with myocardial infarction (MI) have both traditional risk factors and non-traditional risk factors. HTN, smoking, obesity, HLD and a family history of CAD were risks of MI in the young. HIV, SLE, and OSA were all associated with an elevated risk of MI, independent of traditional atherosclerotic risk factors. Close attention should be paid to emerging risk factors such as SLE, HIV and OSA.
Although most prevalent in elderly, myocardial infarction (MI) also affects younger adults. We sought to investigate baseline characteristics in young patients (<55 years) with MI using the National Inpatient Sample (NIS) database between 2004 and 2015. Multivariable logistic regression models were used to assess factors associated with acute myocardial infarction (AMI) in young patients. After multivariable analyses adjusted for age, sex, race, family history of atherosclerosis, body mass index (BMI), diabetes, hypertension, hyperlipidemia, chronic kidney disease, and current cigarette smoking; novel risk factors such as human immunodeficiency virus (HIV), systemic lupus erythematosus (SLE), and obstructive sleep apnea (OSA) were associated with a higher risk of developing an AMI in the young (adjusted OR for HIV 4.06; 95 CI 3.48–4.71, p < 0.001), (adjusted OR for SLE 2.12; 95 CI 1.89–2.39, p 0.04), and (adjusted OR for OSA 1.16; 95 CI 1.12–1.20, p < 0.001), respectively. Rheumatoid arthritis was associated with a lower risk of AMI (adjusted OR 0.83; 95 CI 0.76–0.89, p < 0.001). After multivariable analyses, cigarette smoking (adjusted OR 1.98; 95 CI 1.95–2.02, p < 0.001), obesity (adjusted OR 1.37; 95 CI 1.33–1.41, p = 0.003), hyperlipidemia (adjusted OR 1.07; 95 CI 1.04–1.08, p < 0.001) and a family history of CAD (adjusted OR 1.35; 95 CI 1.3–1.4, p < 0.001) were also associated with a higher risk of developing an AMI in the young. In conclusion, young patients with AMI have both traditional risk factors and non-traditional risk factors. In addition to traditional risk factors, close attention should be paid to emerging risk factors such as SLE, HIV and OSA.
Collapse
Affiliation(s)
- Chayakrit Krittanawong
- Michael E. DeBakey VA Medical Center, Houston, TX, USA.,Section of Cardiology, Baylor College of Medicine, USA.,Department of Cardiology, Icahn School of Medicine at Mount Sinai, Mount Sinai Heart, New York, NY, USA
| | - Yiming Liu
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Dhruv Mahtta
- Michael E. DeBakey VA Medical Center, Houston, TX, USA
| | - Bharat Narasimhan
- Department of Cardiology, Icahn School of Medicine at Mount Sinai, Mount Sinai Heart, New York, NY, USA
| | - Zhen Wang
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA.,Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Hani Jneid
- Michael E. DeBakey VA Medical Center, Houston, TX, USA.,Section of Cardiology, Baylor College of Medicine, USA
| | | | - Alam Mahboob
- Michael E. DeBakey VA Medical Center, Houston, TX, USA
| | - Usman Baber
- Department of Cardiology, Icahn School of Medicine at Mount Sinai, Mount Sinai Heart, New York, NY, USA
| | - Roxana Mehran
- Department of Cardiology, Icahn School of Medicine at Mount Sinai, Mount Sinai Heart, New York, NY, USA
| | - W H Wilson Tang
- Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | | | - Salim S Virani
- Michael E. DeBakey VA Medical Center, Houston, TX, USA.,Section of Cardiology, Baylor College of Medicine, USA
| |
Collapse
|
5
|
Giant Thrombosis at Left Anterior Descending Artery Aneurysm in a 10-Year Old Boy with Granulomatosis with Polyangiitis. Case Rep Cardiol 2020; 2020:3417910. [PMID: 32373370 PMCID: PMC7193272 DOI: 10.1155/2020/3417910] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 03/17/2020] [Indexed: 01/05/2023] Open
Abstract
Granulomatosis with polyangiitis (GPA), necrotizing vasculitis of small and medium-sized vessels, is traditionally believed to mainly affect respiratory tract with additional focal kidney involvements as its primary manifestations with a relatively rare annual incidence rate of 20-50 cases per million. Six percent of the affected cases have cardiac involvements; among which, aneurysms comprise the lowest penetrance. By this paper, we aim to cast light on clinical diagnostic and treatment methods of a rare case presentation, a 10-year-old male GPA patient, diagnosed with massive thrombosis at his coronary artery aneurysm. GPA should be considered as differential diagnosis of prolong fever and coronary aneurysms in adolescents.
Collapse
|
6
|
Pacholczak R, Bazan-Socha S, Iwaniec T, Zaręba L, Kielczewski S, Walocha JA, Musiał J, Dropiński J. Endothelial dysfunction in patients with granulomatosis with polyangiitis: a case-control study. Rheumatol Int 2018; 38:1521-1530. [PMID: 29850964 PMCID: PMC6060787 DOI: 10.1007/s00296-018-4061-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 05/23/2018] [Indexed: 01/09/2023]
Abstract
Background Granulomatosis with polyangiitis (GPA) is a rare granulomatous vasculitis affecting small- and medium-sized blood vessels. In optimally treated patients with long-standing disease, the common cause of death is atherosclerosis even in the absence of typical risk factors. Objective To evaluate endothelial dysfunction in GPA patients. Methods 44 patients (21 men and 23 women) diagnosed with GPA and 53 controls matched for age, sex, BMI and typical risk factors for cardiovascular diseases (22 men and 31 women) were enrolled in the study. We measured each participant’s serum levels of vascular cell adhesion molecule-1 (VCAM-1), interleukin 6 (IL-6), and thrombomodulin. We also studied flow-mediated dilatation (FMD) of the brachial artery, intima-media thickness (IMT) of the common carotid artery and aortic stiffness using echocardiography. Results Patients with GPA showed a 15.9% increase in serum levels of VCAM-1 (p = 0.01), 66% of IL-6 (p < 0.001) and 50.9% of thrombomodulin (p < 0.001) compared to controls. FMD% was 48.9% lower in patients with GPA in comparison to controls (p < 0.001), after adjustment for potential confounders, with no differences regarding IMT or aortic stiffness. FMD% was negatively associated with duration of the disease (β = − 0.18 [95% CI: − 0.32 to − 0.04]), C-reactive protein (β = − 0.17 [95% CI: − 0.27 to − 0.07]), IL-6 (β = − 0.29 [95% CI: − 0.39 to − 0.19]), blood creatinine level (β = − 0.2 [95% CI: − 0.3 to − 0.1]), and IMT (β = − 0.14 (− 0.24 to − 0.04). In a multiple linear regression model, kidney function, IMT, pack-years of smoking, diabetes and level of VCAM-1 were independent predictors of lower FMD%. Conclusion GPA is characterized by endothelial dysfunction. FMD is a useful tool for the detection of endothelial injury. Electronic supplementary material The online version of this article (10.1007/s00296-018-4061-x) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Renata Pacholczak
- Department of Anatomy, Jagiellonian University, Medical College, Cracow, Poland.,Centre of Oncology, Maria Sklodowska-Curie Memorial Institute, Cracow Branch, Cracow, Poland
| | - Stanisława Bazan-Socha
- 2nd Department of Internal Medicine, Jagiellonian University, Medical College, ul.Skawińska 8, 31-066, Cracow, Poland
| | - Teresa Iwaniec
- 2nd Department of Internal Medicine, Jagiellonian University, Medical College, ul.Skawińska 8, 31-066, Cracow, Poland
| | - Lech Zaręba
- Faculty of Mathematics and Natural Sciences, University of Rzeszow, Rzeszow, Poland
| | - Stan Kielczewski
- Department of Anatomy, Jagiellonian University, Medical College, Cracow, Poland
| | - Jerzy A Walocha
- Department of Anatomy, Jagiellonian University, Medical College, Cracow, Poland
| | - Jacek Musiał
- 2nd Department of Internal Medicine, Jagiellonian University, Medical College, ul.Skawińska 8, 31-066, Cracow, Poland
| | - Jerzy Dropiński
- 2nd Department of Internal Medicine, Jagiellonian University, Medical College, ul.Skawińska 8, 31-066, Cracow, Poland.
| |
Collapse
|
7
|
Farooq A, Ullah A, Ali F, Yasin H, Amjad W, Pervaiz M. Acute Myocardial Infarction in Young Systemic Lupus Erythematosus Patient with Normal Coronary Arteries. Cureus 2017; 9:e1370. [PMID: 28744417 PMCID: PMC5519312 DOI: 10.7759/cureus.1370] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
A 34-year-old female with a past medical history of systemic lupus erythematosus (SLE) and a deep venous thrombosis experienced substernal chest pain for 24 hours. Her physical exam was remarkable for brown macular rash over the face. Her initial electrocardiogram showed ST depression in lead V3–V6 along with an elevated troponin I level of 1.23 ng/dl (normal 0.0–0.4) that increased to 2.33 ng/dl in a four-hour duration. Cardiac catheterization revealed mild 10–20% focal plaque in the mid left anterior descending artery and otherwise normal coronary arteries. Laboratory data revealed an erythrocyte sedimentation rate of 98 mm/hour (normal 1–20), C-reactive protein of 25 mg/L (normal 0.0–2.9), and positive antinuclear antibody. In the absence of a significant coronary atherosclerosis along with elevated inflammatory markers, inflammation of coronary microcirculation was considered as an underlying pathophysiology of myocardial infarction. The patient was started on immunosuppression therapy with hydroxychloroquine and prednisone. Her chest pain improved and she was discharged in a stable condition. The patient remained stable and symptom-free over a follow-up period of nine months.
Collapse
Affiliation(s)
- Ali Farooq
- Internal Medicine, West Virginia University - Charleston Division
| | - Aman Ullah
- Internal Medicine, St Joseph Mercy Oakland Hospital
| | - Farman Ali
- Medicine, St.john Hospital and Medical Center, Detroit
| | - Hassaan Yasin
- Internal Medicine, West Virginia University - Charleston Division
| | - Waseem Amjad
- Forest Hills Hospital, Northshore-Long Island Jewish Health System
| | | |
Collapse
|
8
|
Kawada S, Kuriyama M, Tanabe A, Kioka Y. Granulomatosis with Polyangiitis (Wegener's Granulomatosis) Complicated with Ruptured Posteromedial Papillary Muscle in the Absence of Coronary Angiographic Findings. Cardiology 2015; 132:22-5. [PMID: 26021454 DOI: 10.1159/000382096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Accepted: 04/02/2015] [Indexed: 11/19/2022]
Abstract
Granulomatosis with polyangiitis (GPA) is a systemic necrotizing vasculitis, associated with antineutrophil cytoplasmic autoantibody-associated systemic vasculitis, and it can affect many organ systems via the inflammation of small-to-medium-sized vessels. Cardiac involvements in GPA are relatively rare. We report a 75-year-old woman who was diagnosed with GPA and rapid progressive glomerulonephritis that resulted in a partial posteromedial papillary muscle rupture, but with no coronary angiographic findings. The surgical and pathological findings with regard to the ruptured papillary muscle revealed necrotic muscle and acute ischemic change. The mechanism of papillary muscle rupture in GPA is coronary vasculitis leading to myocardial infarction. The ischemic change is not always detected on coronary angiography, so assessment using an echocardiogram is important.
Collapse
Affiliation(s)
- Sachiko Kawada
- Department of Cardiovascular Surgery, Cardiovascular Center, Fukuyama City Hospital, Hiroshima, Japan
| | | | | | | |
Collapse
|
9
|
Standard and feature tracking magnetic resonance evidence of myocardial involvement in Churg-Strauss syndrome and granulomatosis with polyangiitis (Wegener's) in patients with normal electrocardiograms and transthoracic echocardiography. Int J Cardiovasc Imaging 2012; 29:843-53. [PMID: 23212274 PMCID: PMC3644401 DOI: 10.1007/s10554-012-0158-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2012] [Accepted: 11/14/2012] [Indexed: 01/08/2023]
Abstract
The aim of the study was to evaluate the presence and spectrum of cardiac abnormalities identified by cardiac magnetic resonance (CMR) in subjects in clinical remission of Churg-Strauss syndrome (CSS) and granulomatosis with polyangiitis (Wegener's) (WG) with normal ECG and transthoracic echocardiography (TTE). Eleven (7 females, 4 males, mean age 42.4 ± 9.6 years) CSS and 10 (4 females, 6 males, mean age 45.3 ± 10.9 years) WG patients in clinical remission with normal ECG and TTE underwent CMR. Segmental peak-systolic myocardial strain (εps) was measured using feature tracking cine-sequence based technique. Left ventricular (LV) ejection fraction, end-diastolic volume and myocardial mass indexes were 66.2 ± 5.8 %, 66.1 ± 6.6 ml/m(2), and 61.0 ± 8.9 g/m(2), respectively. No patient showed regional wall motion abnormalities and signs of myocarditis. Nine CSS and 8 WG patients demonstrated decreased segmental longitudinal, circumferential or radial εps and myocardial late gadolinium enhancement (LGE) (6 subendocardial, 10 midwall, 8 subepicardial) areas. In CSS and WG subjects with LVLGE lesions the mean LVLGE extent was 2.0 ± 1.6 % and 2.3 ± 1.5 % (p = 0.65), respectively. Segmental εps was decreased longitudinally (-11.8 ± 5.6 %) for subendocardial LGE, radially (13.7 ± 8.7 %) for subepicardial LGE, and circumferentially (-16.6 ± 4.2 %), longitudinally (-13.2 ± 5.5 %) and radially (18.8 ± 8.1 %) for midwall LGE, if compared to longitudinal (-22.7 ± 5.1 %), circumferential (-23.6 ± 5.6 %) and radial (34.2 ± 15.7 %) εps in controls (11 females, 10 males, mean age 43.9 ± 10.5 years) (all p < 0.01). Despite clinical remission, normal ECG and TTE, most CSS and WG patients demonstrate decreased segmental εps and non-ischemic LGE lesions without signs of myocarditis.
Collapse
|
10
|
Salazar-Exaire D, Ramos-Gordillo M, Vela-Ojeda J, Salazar-Cabrera CE, Sanchez-Uribe M, Calleja-Romero MC. Silent Ischemic Heart Disease in a Patient with Necrotizing Glomerulonephritis due to Wegener's Granulomatosis. Cardiorenal Med 2012; 2:218-224. [PMID: 22969778 DOI: 10.1159/000339551] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2012] [Accepted: 05/09/2012] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE: Wegener's granulomatosis (WG) is a necrotizing vasculitis that mainly affects the respiratory tract and kidneys, but can also affect other systems such as the eye, joints, skin, muscles, nerves, and gastrointestinal tract. Cardiac involvement is traditionally believed to be rare. We report a patient with silent myocardial infarction (MI) and review previously reported cases showing this association. METHODS: A Medline database search of cases published between January 1978 and July 2008 both in English and Spanish, reporting silent MI complicating WG, was conducted. RESULTS: We describe a typical patient with WG who had both respiratory and renal involvement and died unexpectedly following a silent MI after a period of clinical improvement induced by treatment with prednisone and cyclophosphamide. We report necropsy findings and the association with 5 additional cases of WG with silent MI reported in the literature. CONCLUSIONS: Clinicians should be aware of potential cardiac involvement due to WG. Careful evaluation of each patient, with or without cardiac symptoms, using ECG, echocardiogram, and myocardial enzymes is prudent.
Collapse
|