Vasculitis Presenting with Myocardial Infarction, Stroke, and Aortitis in a Middle-aged Man

Wheeler, Gregory L.; Kropf, Jesse A.H.; Jeanmonod, Rebecca

doi:10.1016/j.jemermed.2010.05.036

Cited by 9 publications

(10 citation statements)

References 17 publications

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“…Her unusual presentation highlights the importance of considering GCA in the causes of aortitis [11,12], where prompt corticosteroid and immunosuppressive therapy to improve clinical outcomes in GCA [7,8,10]. It must be stressed, however, that there are no guidelines to treat coronary lesions related to GCA.…”

Section: Discussionmentioning

confidence: 99%

“…About 20% of patients with GCA develop aortitis [10][11][12], that may sometimes reveal the diagnosis. Many of these cases develop aortic aneurysms with a high risk of aortic rupture [11,12].…”

Section: Discussionmentioning

confidence: 99%

“…It must be stressed, however, that there are no guidelines to treat coronary lesions related to GCA. The alterations of the wall of the vessels may result in a high rate of re-stenosis after invasive procedures [10]. The short-term prognosis of GCA myocardial infarction is poor, and it may increase mortality if corticosteroid therapy is delayed [5,6,9,12].…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…Giant cell arteritis (GCA) affects mainly arteries of large and medium caliber, especially the extra-cranial branches of the carotids. It may rarely affect coronary vessels [1][2][3][4][5][6][7][8][9][10][11][12].Although easily identified if a patient presents with typical symptoms, this diagnosis may often be complicated if the condition shows atypical clinical features.We report a case of a woman diagnosed with aortitis, celiac trunk inflammation and an acute myocardial infarction due to coronary vasculitis secondary to GCA. …”

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confidence: 99%

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Myocardial Infarction, Aortitis and Celiac Trunk Inflammation in Giant Cell Arteritis: A Case Report

Berriche¹

2017

EMIJ

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We report a rare case of a 62-year-old woman admitted for investigation of unexplained inflammatory syndrome. Her atypical clinical presentation included a lack of headache and systemic signs. Computed tomography scan showed thoracic, abdominal aortitis and celiac trunk inflammation. A temporal artery biopsy was consistent with giant cell arteritis (GCA). She was treated with corticosteroids with a good response. Her unusual clinical presentation highlights the importance of considering GCA in the causes of aortitis and myocardial infarction in patients over 50 years, where prompt corticosteroid treatment results in satisfactory outcomes.Retrosternal pain appeared on 7th day of hospitalization. An electrocardiogram revealed sinus rhythm of 75 beats/minute and ST-segment elevations in leads V1 to V5. Laboratory tests showed increased total plasma creatine kinase activity 561 U/l (normal range 25-195 U/l), and the blood troponin I level rose to 0.57μg/l 4 hour later (normal values < 0.1 μg/l).Because coronary vasculitis was suspected, intravenous administration of unfractioned heparin and acetylsalicylic acid were initiated and resulting in a relief of the chest pain and resolution of ST segment changes on electrocardiogram within 24 hours. Echocardiogram revealed hypokinesia of the apical segment of the anterior wall, as well as diminished left ventricular ejection fraction of approximately 45%. Coronary angiography performed later revealed no significant lesion.On discharge, corticosteroid therapy was continued and tapered 6 weeks later. The patient did not experience further episodes of chest pain or other cardiovascular complications during 1year of follow-up. IntroductionFew cases of acute coronary events are related to non atherosclerotic processes, such as coronary embolism, dissection, congenital abnormalities and vasculitis [1]. Giant cell arteritis (GCA) affects mainly arteries of large and medium caliber, especially the extra-cranial branches of the carotids. It may rarely affect coronary vessels [1][2][3][4][5][6][7][8][9][10][11][12].Although easily identified if a patient presents with typical symptoms, this diagnosis may often be complicated if the condition shows atypical clinical features.We report a case of a woman diagnosed with aortitis, celiac trunk inflammation and an acute myocardial infarction due to coronary vasculitis secondary to GCA. Case ReportA 62-year-old woman with 4 day history of moderate headaches was admitted to the department of Internal Medicine for investigation. On admission, her pulse rate 74 beats/min, arterial blood pressure was 110/70 mmHg, symmetrical over upper and lower extremity arteries. All peripheral pulses were present. The remaining physical examination was normal.Laboratory tests showed hemoglobin 8.5 g/dl, white blood cell count 10250/mm3, erythrocyte sedimentation rate was 124 mm/hour, and level of C -reactive protein was 59 mg/l, serum fibrinogen concentration 5.4 g/l, serum albumin level 36 g/l and an increased serum globulin 16.8 g/l. Other laborat...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

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Myocardial Infarction, Aortitis and Celiac Trunk Inflammation in Giant Cell Arteritis: A Case Report

Berriche¹

2017

EMIJ

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Cerebrovascular events in Takayasu arteritis: a multicenter case-controlled study

et al. 2018

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Giant cell arteritis of the thyroid in a 69-year-old male

Glassy

Guggenheim

2012

Mod Rheumatol

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We report the case of a 69-year-old Caucasian male with a histological confirmed diagnosis of giant cell arteritis (GCA) of the thyroid. To our knowledge this is the second reported case of GCA of the thyroid with a histological confirmed diagnosis. Unique to this case is that our patient did not have the simultaneous occurrence of a positive temporal artery biopsy or classic symptoms of temporal arteritis. The patient presented with fever of unknown origin, and fatigue. Laboratory reports included a sedimentation rate of >100 mm/h and C-reactive protein level of 17.1 mg/dL. Goiter with irregular calcifications was found on the computed tomography image. Temporal artery biopsy was negative. The patient continued to have intermittent fever after discharge and was readmitted to the hospital 41 days after discharge for fever and increasing fatigue. The thyroid was resected to rule out neoplasia. Granulomatous GCA was identified within the thyroid specimen.

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Vasculitis Presenting with Myocardial Infarction, Stroke, and Aortitis in a Middle-aged Man

Cited by 9 publications

References 17 publications

Myocardial Infarction, Aortitis and Celiac Trunk Inflammation in Giant Cell Arteritis: A Case Report

Myocardial Infarction, Aortitis and Celiac Trunk Inflammation in Giant Cell Arteritis: A Case Report

Cerebrovascular events in Takayasu arteritis: a multicenter case-controlled study

Giant cell arteritis of the thyroid in a 69-year-old male

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