Vasculitis presenting with myocardial infarction, stroke, and aortitis in a middle-aged man

Abstract

Background: Vasculitis may cause inflammation in any single or group of blood vessels. Traditionally, giant cell arteritis involves the extracranial branches of the carotid, and Takayasu arteritis affects the aorta and its major branches. These diseases are quite rare, but have the potential to be fatal.

Objectives: We describe the spectrum of overlap between these two historically distinct diseases, and use a case of a man with arteritis involving his carotid and vertebral vessels, aorta, and coronary arteries to illustrate this. We posit that large-vessel vasculitis should be considered in the differential for young and middle-aged patients presenting with multiple vascular events.

Case report: Over a 2-month period, a 46-year-old man presented on four separate occasions to the Emergency Department. Each time, he was diagnosed with a vascular event. His first two visits were for myocardial infarction and unstable angina, his third visit was for a cerebrovascular event, and his fourth visit was for aortitis. He was not diagnosed with the underlying vasculitic process until his last visit. He ultimately succumbed to non-aneurysmal aortic rupture from his aortitis.

Conclusions: In middle-aged persons with multiple vascular events, an underlying inflammatory process should be considered. These diseases are rare, but they are treatable; and missed diagnoses can be catastrophic.