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Case Reports
. 2021 Feb 10;3(2):309-313.
doi: 10.1016/j.jaccas.2020.12.007. eCollection 2021 Feb.

Isolated Antineutrophil Cytoplasmic Antibody-Associated Coronary Vasculitis and Valvulitis

Yoon Kook Kim  1 , Praveen Chekka  1 , Manu Mysore  1 , James Childress  1 , Maha Alfaraidhy  1 , Afton Thomas  1 , Bradley Taylor  1 , Jamal Mikdashi  1 , Stanley Liu  1 , Libin Wang  1
Affiliations
Case Reports

Isolated Antineutrophil Cytoplasmic Antibody-Associated Coronary Vasculitis and Valvulitis

Yoon Kook Kim et al. JACC Case Rep. .

Abstract

A 30-year-old woman presented with angina pectoris. Coronary angiography revealed severe stenosis in the left main and right coronary arteries that did not improve with intracoronary nitroglycerin. Coronary computed tomography angiography and positron emission tomography revealed coronary ostia inflammation and aortic root fat stranding. She was diagnosed with vasculitis and valvulitis and received immunotherapy and coronary bypass. (Level of Difficulty: Advanced.).

Keywords: AAV, ANCA associated vasculitis; ANCA, antineutrophil cytoplasmic antibody; CABG, coronary artery bypass grafting; CTA, computed tomography angiography; FDG, fluorodeoxyglucose; LMCA, left main coronary artery; MPA, microscopic polyangiitis; MRA, magnetic resonance angiography; PET, positron emission tomography; RCA, right coronary artery; aortic valve; autoimmune; coronary artery bypass; vascular disease.

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Conflict of interest statement

The authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Figures

None
Graphical abstract
Figure 1
Figure 1
Coronary Angiogram and Coronary CTA Computed tomography image produced with 0.75-mm slice thickness and reconstructed to produce 3-dimensional images and limit confounding related to the image plane. Blue arrows highlight the asymmetry of the aortic wall, measuring at 3 mm near the left main (LM) artery. (A) Coronary angiography showing severe narrowing of the left main coronary artery (LMCA) ostium. (B) Coronary angiography showing narrowing of the right coronary artery (RCA) ostium. (C) Computed tomography angiography (CTA) showing 70% stenosis at the LMCA ostium with aortic root fat stranding. (D) CTA showing RCA without stenosis.
Figure 2
Figure 2
Positron Emission Tomography/Computed Tomography Arrow indicating increased fluorodeoxyglucose activity (standardized uptake value max 5.6.) at the LMCA ostium. No evidence of aortitis or great vessel involvement.
Figure 3
Figure 3
Coronary CTA Follow-Up Images obtained with 0.75-mm slice thickness. Mild decrease in circumferential aortic root fat stranding with interval decrease in the left main ostial stenosis. Newly observed focal inflammatory changes around the RCA ostium with 15% to 25% stenosis compared with Figure 1D. Abbreviations as in Figure 1.
See this image and copyright information in PMC

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