Acute ST elevation myocardial infarction in fulminant systemic p-ANCA vasculitis: a rare catastrophic complication

Abstract

A 45-year-old Caucasian man presented to the hospital with a 3-month history of fatigue, bilateral upper and lower limb paresthesias and gradually worsening ascending paralysis. A few weeks later, he developed acute renal failure requiring haemodialysis. Investigations revealed presence of myeloperoxidase (MPO) perinuclear antineutrophil cytoplasmic antibodies (ANCA). Renal biopsy was conclusive for rapidly progressive glomerulonephritis with crescents. Treatment for ANCA positive vasculitis was initiated with pulsed steroids, cyclophosphamide and plasmapheresis. The hospital course took an unexpected turn when the patient developed acute chest pain with an EKG consistent with inferior ST elevation myocardial infarction (STEMI). Urgent left heart catheterisation revealed distal occlusions in multivessel coronary distribution. Coronary involvement is rare in ANCA vasculitis and STEMI has not been reported in MPO-ANCA positive vasculitis, to the best of our knowledge.

Isolated Antineutrophil Cytoplasmic Antibody-Associated Coronary Vasculitis and Valvulitis

“…( 3 ) demonstrated that patients with AAV carried an increased relative risk for all cardiovascular diseases. However, AAVs are predominantly small vessel diseases, and isolated coronary artery or valvular involvement is rare and mostly found incidentally on imaging or on autopsy ( 4 ). Only 2 cases of MPA with coronary involvement were reported in our literature review.…”

“…A Japanese autopsy report of a woman with MPA revealed scattered infarcts in the left ventricular wall and septum without coronary obstruction ( 5 ). The other case reported multiple distal coronary stenosis that could not go undergo intervention ( 4 ). Our case was the only reported case of MPA with isolated coronary and valvular involvement that required CABG.…”

Myocardial infarction with non-obstructive coronary arteries in a patient double-seropositive for anti-glomerular basement membrane and anti-neutrophil cytoplasmic antibodies: A case report

“…Cardiovascular (CV) events are among the leading causes of death in AAV; thus, a more complex understanding of CV manifestations and their risk factors is required (4). In line, cardiac involvement is an underdiagnosed manifestation in AAV, and involvement of the coronary arteries is only rarely reported (5)(6)(7)(8)(9). Our case illustrates that myocardial infarction with non-obstructive coronary arteries (MINOCA) might be an important contributor to cardiac complications seen in patients with AAV and/or anti-GBM disease.…”