Granulomatosis with Polyangiitis Presenting with Coronary Artery and Pericardial Involvement

Case Reports in Radiology
Rohit DewanIclal Ocak

Abstract

Granulomatosis with polyangiitis is a systemic disease resulting in necrotizing vasculitis of small- and medium-sized vessels. Cardiac involvement is rare and when present usually manifests with pericarditis and coronary artery vasculitis. We report here a case of granulomatosis with polyangiitis involving the native coronary arteries, bypass graft, and pericardium with interesting imaging findings on contrast-enhanced CT and MRI. A 57-year-old man with a history of chronic headaches presented to the emergency room with syncope. Contrast-enhanced CT demonstrated extensive soft tissue attenuation around the native coronary arteries and bypass graft. Contrast-enhanced MRI demonstrated enhancing nodular soft tissue surrounding the coronary arteries, bypass graft, and pericardium. Pericardial biopsy revealed a necrotizing granulomatous pericarditis with vasculitis concerning for granulomatosis with polyangiitis. The patient demonstrated MPO-positive and PR-3 negative serologies. After being discharged on rituximab and prednisone, follow-up CT 3 years later showed significant improvement of the soft tissue thickening surrounding the coronary arteries, bypass graft, and pericardium.

References

Mar 15, 1992·Annals of Internal Medicine·G S HoffmanA S Fauci
Jan 13, 2012·Radiographics : a Review Publication of the Radiological Society of North America, Inc·Felipe MartinezAmita Sharma
Oct 10, 2012·Arthritis and Rheumatism·J C JennetteR A Watts
Sep 10, 2014·Cardiovascular Pathology : the Official Journal of the Society for Cardiovascular Pathology·Olivier EspitiaClaire Toquet
May 3, 2015·The Journal of Rheumatology·Lucy McGeochUNKNOWN Vasculitis Clinical Research Consortium

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Citations

Jul 1, 2017·BMJ Case Reports·Vikram RaghunathanGerardo Carino

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Methods Mentioned

BETA
ESR
biopsies
biopsy

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