Rare Clinical Manifestation of Vasculitis
Background: Antineutrophil cytoplasm antibody (ANCA)-associated vasculitis usually affects small blood vessels and is characterized by the presence of circulating autoantibodies (c-ANCA or p-ANCA). The risk of cardiovascular events is threefold higher compared to general population, and cardiac mani...
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2024-11-01
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| author | Oana-Mădălina Manole Mihai Ștefan Cristian Haba Iulian-Theodor Matei Viviana Onofrei |
| author_facet | Oana-Mădălina Manole Mihai Ștefan Cristian Haba Iulian-Theodor Matei Viviana Onofrei |
| author_sort | Oana-Mădălina Manole |
| collection | DOAJ |
| description | Background: Antineutrophil cytoplasm antibody (ANCA)-associated vasculitis usually affects small blood vessels and is characterized by the presence of circulating autoantibodies (c-ANCA or p-ANCA). The risk of cardiovascular events is threefold higher compared to general population, and cardiac manifestations include myocarditis, pericarditis, valvulitis, aortitis, or coronary arteritis. Coronary involvement is very rare, but it is a potentially life-threatening manifestation. Methods: We present an atypical cardiac scenario of p-ANCA vasculitis. Results: A 68-year-old woman with known p-ANCA vasculitis and stage 5 chronic kidney disease (CKD) on hemodialysis presented with dizziness accompanied by low blood pressure and chest pain. Electrocardiogram on arrival showed slightly ST-T changes, with negative cardiac biomarkers and no abnormalities in cardiac regional wall motion. Five hours after presentation, the patient repeated chest pain, accompanied by a drop in blood pressure and junctional escape rhythm. The highly sensitive cardiac troponin I (hs-cTnI) was raised at 560 ng/L. Coronary angiography showed coronary arteries without significant stenosis. The provocative test with intracoronary ergonovine demonstrated coronary vasospasm of the anterior descending artery accompanied by chest pain, with resolution after intracoronary nitroglycerin. Under amlodipine, nitrate, acetylsalicylic acid, statin and corticosteroids the patient did not experience the recurrence of angina. Conclusions: This case illustrates coronary involvement, manifested as coronary spasm with favorable outcomes, in systemic vasculitis. The underlying mechanism is immune-mediated inflammation in vascular walls. |
| format | Article |
| id | doaj-art-d44a7e3af519416aa9c87aa5ead21337 |
| institution | DOAJ |
| issn | 2075-4418 |
| language | English |
| publishDate | 2024-11-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Diagnostics |
| spelling | doaj-art-d44a7e3af519416aa9c87aa5ead213372025-08-20T02:50:13ZengMDPI AGDiagnostics2075-44182024-11-011423262310.3390/diagnostics14232623Rare Clinical Manifestation of VasculitisOana-Mădălina Manole0Mihai Ștefan Cristian Haba1Iulian-Theodor Matei2Viviana Onofrei3Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, RomaniaFaculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, RomaniaFaculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, RomaniaFaculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, RomaniaBackground: Antineutrophil cytoplasm antibody (ANCA)-associated vasculitis usually affects small blood vessels and is characterized by the presence of circulating autoantibodies (c-ANCA or p-ANCA). The risk of cardiovascular events is threefold higher compared to general population, and cardiac manifestations include myocarditis, pericarditis, valvulitis, aortitis, or coronary arteritis. Coronary involvement is very rare, but it is a potentially life-threatening manifestation. Methods: We present an atypical cardiac scenario of p-ANCA vasculitis. Results: A 68-year-old woman with known p-ANCA vasculitis and stage 5 chronic kidney disease (CKD) on hemodialysis presented with dizziness accompanied by low blood pressure and chest pain. Electrocardiogram on arrival showed slightly ST-T changes, with negative cardiac biomarkers and no abnormalities in cardiac regional wall motion. Five hours after presentation, the patient repeated chest pain, accompanied by a drop in blood pressure and junctional escape rhythm. The highly sensitive cardiac troponin I (hs-cTnI) was raised at 560 ng/L. Coronary angiography showed coronary arteries without significant stenosis. The provocative test with intracoronary ergonovine demonstrated coronary vasospasm of the anterior descending artery accompanied by chest pain, with resolution after intracoronary nitroglycerin. Under amlodipine, nitrate, acetylsalicylic acid, statin and corticosteroids the patient did not experience the recurrence of angina. Conclusions: This case illustrates coronary involvement, manifested as coronary spasm with favorable outcomes, in systemic vasculitis. The underlying mechanism is immune-mediated inflammation in vascular walls.https://www.mdpi.com/2075-4418/14/23/2623vasculitisMINOCAvasospastic angina |
| spellingShingle | Oana-Mădălina Manole Mihai Ștefan Cristian Haba Iulian-Theodor Matei Viviana Onofrei Rare Clinical Manifestation of Vasculitis Diagnostics vasculitis MINOCA vasospastic angina |
| title | Rare Clinical Manifestation of Vasculitis |
| title_full | Rare Clinical Manifestation of Vasculitis |
| title_fullStr | Rare Clinical Manifestation of Vasculitis |
| title_full_unstemmed | Rare Clinical Manifestation of Vasculitis |
| title_short | Rare Clinical Manifestation of Vasculitis |
| title_sort | rare clinical manifestation of vasculitis |
| topic | vasculitis MINOCA vasospastic angina |
| url | https://www.mdpi.com/2075-4418/14/23/2623 |
| work_keys_str_mv | AT oanamadalinamanole rareclinicalmanifestationofvasculitis AT mihaistefancristianhaba rareclinicalmanifestationofvasculitis AT iuliantheodormatei rareclinicalmanifestationofvasculitis AT vivianaonofrei rareclinicalmanifestationofvasculitis |