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Unusual presentation of more common disease/injury
CASE REPORT
Cardiogenic shock from coronary vasculitis in granulomatosis with polyangiitis
  1. Vikram Raghunathan,
  2. Aryeh Pelcovits,
  3. Daniel Gutman,
  4. Gerardo Carino
  1. Department of Medicine, Brown University Warren Alpert Medical School, Providence, Rhode Island, USA
  1. Correspondence to Dr Gerardo Carino, Gerardo_Carino{at}brown.edu

Summary

Granulomatosis with polyangiitis (GPA) is a systemic vasculitis characterised by necrotising inflammatory changes in small-sized and medium-sized vessels and granuloma formation. It most commonly involves the kidneys and respiratory tract, but it can present with widespread manifestations involving any organ system. Rarely, it causes coronary vasculitis which can precipitate a severe cardiomyopathy. Here, we report a patient who presented in cardiogenic shock requiring vasopressors and was found to have extensive myocardial ischaemia secondary to coronary vasculitis. Further investigation led to a diagnosis of GPA, and he responded to treatment with corticosteroids, cyclophosphamide and plasmapheresis.

  • cardiovascular medicine
  • ischaemic heart disease
  • vasculitis
  • rheumatology

https://doi.org/10.1136/bcr-2017-220233

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    Footnotes

    • Contributors VR was involved in the planning, outline, background research including literature review and writing of this manuscript. He also edited and formatted the document and incorporated images. AP took part in the planning and background research for the paper and wrote sections of the manuscript. He also acquired and reviewed the cardiac catheterisation images. DG was involved in the planning and literature review for this paper, writing of the manuscript and editing and revision prior to submission. GC played a role in the planning and organisation of the project, acquisition of patient data and revision of the manuscript. All four physicians above were involved in the care of this patient.

    • Competing interests None declared.

    • Patient consent Obtained.

    • Provenance and peer review Not commissioned; externally peer reviewed.