SHM Converge Scientific Abstract ePoster Gallery-My Anc(a)y Breaky Heart: A Case of Autoimmune Heartache

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This case describes a 24-year-old woman with newly diagnosed granulomatosis with polyangiitis (GPA) who developed a serious cardiac complication during hospitalization. Her initial GPA presentation included pulmonary nodules, a large cavitary lung lesion, skin lesions consistent with pyoderma gangrenosum, positive c-ANCA, and bronchoscopy findings supporting the diagnosis. After discharge on a steroid taper, she was readmitted with anterior scleritis and signs of active inflammation, including tachycardia, leukocytosis, markedly elevated CRP, microscopic hematuria, and red blood cell casts.<br /><br />On hospital day 4, she developed acute substernal chest pain that worsened when reclining. Although the initial ECG was normal, troponin was significantly elevated and had already been high 48 hours before symptoms began, suggesting subclinical cardiac involvement. Echocardiography showed reduced apical contractility, and cardiac MRI demonstrated diffuse hypokinesis with a non-ischemic pattern of enhancement consistent with myocarditis. Her ECG later evolved to show lateral T-wave inversions, and troponin peaked at 21,000 ng/L. Cardiology recommended left heart catheterization, and the overall picture was most consistent with non-ST-elevation myocardial infarction due to coronary arteritis.<br /><br />The patient was treated aggressively with high-dose steroids, cyclophosphamide, avacopan, rituximab, and therapeutic plasma exchange. Renal biopsy was deferred because the vasculitic diagnosis was already clear. She also received medical therapy to reduce cardiovascular risk.<br /><br />The case emphasizes that coronary arteritis is an uncommon but life-threatening manifestation of GPA that can cause myocardial infarction even without traditional cardiovascular risk factors. Clinicians should maintain a high suspicion for cardiac involvement in GPA flares, since early recognition and prompt immunosuppression are essential to reduce morbidity and mortality.

Asset Subtitle

Jonathon Heath

Meta Tag

Author List Ann Marie Kumfer, Hannah E. Dee, Jessica L. Guidici, Jonathon Heath

Category Clinical Vignettes

Concept Coronary Vasculitis

Concept Granulomatosis with Polyangiitis

Concept Myocardial Infarction

Concept Cardiac Involvement

Concept Immunosuppressive Therapy

Distinguished Non-Finalist

Presenter Organization UNC Hospital

Presenting Author Jonathon Heath

Track Adult

Keywords

granulomatosis with polyangiitis

GPA

coronary arteritis

myocardial infarction

myocarditis

troponin elevation

cardiac MRI

c-ANCA

scleritis

immunosuppression

Coronary Vasculitis

Granulomatosis with Polyangiitis

Myocardial Infarction

Cardiac Involvement

Immunosuppressive Therapy