Angina in granulomatosis with polyangiitis: A case report

Abstract

Granulomatosis with polyangiitis (GPA) often causes small blood vessel lesions in multiple organs, with less impact on large vessels. We report a case involving not only large blood vessels, but also angina. The computed tomographic angiography of large vessels and vascular ultrasonography of the extremity also suggested great arteries of the body were involved. Further cytoplasmic antineutrophil cytoplasmic antibody tests, pathological examination and dynamic chest computed tomography scan confirmed the diagnosis of GPA. Anti-inflammatory therapy and coronary secondary prevention were given after diagnosis by pathological examination and laboratory evaluation. The symptoms of angina pectoris were relieved. This rare case report reminds us that among the well-known risk factors of atherosclerotic diseases, GPA is also an important risk factor for acute coronary syndrome. Early foresight for this rare risk factor can improve the early diagnosis and treatment of the disease, which will improve the prognosis of the patients.

Keywords: acute coronary syndrome; angina; atherosclerosis; granulomatosis with polyangiitis; rheumatic immunity.

Figure 1.

Comprehensive physical examination in 2015. (A and B) CT angiography of the renal (yellow arrow), iliac (red arrow) and femoral arteries (blue arrow). (C) Carotid ultrasound. (D) Axillary artery ultrasound.

Figure 2.

The dynamic changes of the lung CT scan. (A) The lung CT in 2015. (B) The lung CT in 2016 without hormone therapy. Arrows indicate granulomatous nodules. (C) The lung CT in 2016 after hormone therapy.