title: Granulomatosis with Polyangiitis Presenting with Coronary Artery and Pericardial Involvement.
abstract: Granulomatosis with polyangiitis is a systemic disease resulting in necrotizing vasculitis of small- and medium-sized vessels. Cardiac involvement is rare and when present usually manifests with pericarditis and coronary artery vasculitis. We report here a case of granulomatosis with polyangiitis involving the native coronary arteries, bypass graft, and pericardium with interesting imaging findings on contrast-enhanced CT and MRI. A 57-year-old man with a history of chronic headaches presented to the emergency room with syncope. Contrast-enhanced CT demonstrated extensive soft tissue attenuation around the native coronary arteries and bypass graft. Contrast-enhanced MRI demonstrated enhancing nodular soft tissue surrounding the coronary arteries, bypass graft, and pericardium. Pericardial biopsy revealed a necrotizing granulomatous pericarditis with vasculitis concerning for granulomatosis with polyangiitis. The patient demonstrated MPO-positive and PR-3 negative serologies. After being discharged on rituximab and prednisone, follow-up CT 3 years later showed significant improvement of the soft tissue thickening surrounding the coronary arteries, bypass graft, and pericardium.
authors.affiliation: University of Pittsburgh Medical Center, Radiology Suite 200 East Wing, 200 Lothrop Street, Pittsburgh, PA 15213, USA.
authors.forename: Rohit
authors.initials: R
authors.lastname: Dewan
authors.affiliation: University of Pittsburgh Medical Center, Department of Pathology A711 Scaife Hall, 3550 Terrace Street, Pittsburgh, PA 15261, USA.
authors.forename: Humberto E
authors.initials: HE
authors.lastname: Trejo Bittar
authors.affiliation: University of Pittsburgh Medical Center, Radiology Suite 200 East Wing, 200 Lothrop Street, Pittsburgh, PA 15213, USA.
authors.forename: Joan
authors.initials: J
authors.lastname: Lacomis
authors.affiliation: University of Pittsburgh Medical Center, Radiology Suite 200 East Wing, 200 Lothrop Street, Pittsburgh, PA 15213, USA.
authors.forename: Iclal
authors.initials: I
authors.lastname: Ocak