Massive haemoptysis following recurrent ST-elevation myocardial infarction due to undiagnosed granulomatosis with polyangiitis

被引:2
作者
Benjanuwattra, Juthipong [1 ]
Abdelnabi, Mahmoud Hassan [1 ,2 ]
Mekraksakit, Poemlarp [1 ]
Ansari, Mohammad Mehdi [3 ]
机构
[1] Texas Tech Univ, Hlth Sci Ctr, Dept Internal Med, Lubbock, TX 79430 USA
[2] Alexandria Univ Med Res Inst, Clin & Expt Internal Med Dept, Cardiol & Angiol Unit, Alexandria, Egypt
[3] Texas Tech Univ, Hlth Sci Ctr, Dept Cardiol, Lubbock, TX USA
关键词
interventional cardiology; cardiovascular medicine; vasculitis; interstitial lung disease; PERCUTANEOUS CORONARY INTERVENTION; DIFFUSE ALVEOLAR HEMORRHAGE; WEGENERS;
D O I
10.1136/bcr-2021-246748
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Granulomatosis with polyangiitis (GPA) is a rare small-vessel vasculitis associated with high mortality without appropriate treatment. Acute ST-elevation myocardial infarction (STEMI) has been reported as an atypical presentation of GPA. We report a case of STEMI, shortly followed by subacute in-stent thrombosis with extensive thrombus burden in a 53-year-old male patient with undiagnosed GPA. After aggressive treatment with triple therapy consisting of aspirin, clopidogrel and rivaroxaban, He started to have haemoptysis. Despite the discontinuation of aspirin, he ended up with massive haemoptysis and acute respiratory failure necessitating endotracheal intubation. CT of the chest revealed bilateral ground-glass opacities consistent with diffuse alveolar haemorrhage. Extensive workup revealed positive antiproteinase 3 antibodies; hence, a diagnosis of GPA was made. He was treated with induction therapy consisting of methylprednisolone, mycophenolate mofetil, cyclophosphamide and rituximab, leading to a gradual improvement in his clinical conditions and subsequent extubation.
引用
收藏
页数:3
相关论文
共 19 条
[1]   Accelerated atherosclerosis in patients with Wegener's granulomatosis [J].
de Leeuw, K ;
Sanders, JS ;
Stegeman, C ;
Smit, A ;
Kallenberg, CG ;
Bijl, M .
ANNALS OF THE RHEUMATIC DISEASES, 2005, 64 (05) :753-759
[2]   Adverse impact of bleeding on prognosis in patients with acute coronary syndromes [J].
Eikelboom, John W. ;
Mehta, Shamir R. ;
Anand, Sonia S. ;
Xie, Changchun ;
Fox, Keith A. A. ;
Yusuf, Salim .
CIRCULATION, 2006, 114 (08) :774-782
[3]   MYOCARDIAL-INFARCTION IN WEGENERS GRANULOMATOSIS [J].
GATENBY, PA ;
LYTTON, DG ;
BULTEAU, VG ;
OREILLY, B ;
BASTEN, A .
AUSTRALIAN AND NEW ZEALAND JOURNAL OF MEDICINE, 1976, 6 (04) :336-340
[4]   Clinical manifestations of granulomatosis with polyangiitis: key considerations and major features [J].
Grygiel-Gorniak, Bogna ;
Limphaibool, Nattakarn ;
Perkowska, Katarzyna ;
Puszczewicz, Mariusz .
POSTGRADUATE MEDICINE, 2018, 130 (07) :581-596
[5]   Diffuse alveolar hemorrhage as a complication of dual antiplatelet therapy for acute coronary syndrome [J].
Ikeda, Masataka ;
Tanaka, Haruki ;
Sadamatsu, Kenji .
CARDIOVASCULAR REVASCULARIZATION MEDICINE, 2011, 12 (06) :407-411
[6]   Aspirin versus clopidogrel for chronic maintenance monotherapy after percutaneous coronary intervention (HOST-EXAM): an investigator-initiated, prospective, randomised, open-label, multicentre trial [J].
Koo, Bon-Kwon ;
Kang, Jeehoon ;
Park, Kyung Woo ;
Rhee, Tae-Min ;
Yang, Han-Mo ;
Won, Ki-Bum ;
Rha, Seung-Woon ;
Bae, Jang-Whan ;
Lee, Nam Ho ;
Hur, Seung-Ho ;
Yoon, Junghan ;
Park, Tae-Ho ;
Kim, Bum Soo ;
Lim, Sang Wook ;
Cho, Yoon Haeng ;
Jeon, Dong Woon ;
Kim, Sang-Hyun ;
Han, Jung-Kyu ;
Shin, Eun-Seok ;
Kim, Hyo-Soo .
LANCET, 2021, 397 (10293) :2487-2496
[7]   Update on Diffuse Alveolar Hemorrhage and Pulmonary Vasculitis [J].
Krause, Megan L. ;
Cartin-Ceba, Rodrigo ;
Specks, Ulrich ;
Peikert, Tobias .
IMMUNOLOGY AND ALLERGY CLINICS OF NORTH AMERICA, 2012, 32 (04) :587-+
[8]   Wegener's granulomatosis presenting with an acute ST-elevation myocardial infarct (STEMI) [J].
Lazarus, M. N. ;
Khurana, R. ;
Sethi, A. S. ;
Naughton, M. A. .
RHEUMATOLOGY, 2006, 45 (07) :916-918
[9]   Cardiac Involvement in Granulomatosis with Polyangiitis [J].
McGeoch, Lucy ;
Carette, Simon ;
Cuthbertson, David ;
Hoffman, Gary S. ;
Khalidi, Nader ;
Koening, Curry L. ;
Langford, Carol A. ;
McAlear, Carol A. ;
Moreland, Larry ;
Monach, Paul A. ;
Seo, Philip ;
Specks, Ulrich ;
Ytterberg, Steven R. ;
Merkel, Peter A. ;
Pagnoux, Christian .
JOURNAL OF RHEUMATOLOGY, 2015, 42 (07) :1209-1212
[10]   Mechanisms of thrombosis in ANCA-associated vasculitis [J].
Misra, Durga Prasanna ;
Thomas, Koshy Nithin ;
Gasparyan, Armen Yuri ;
Zimba, Olena .
CLINICAL RHEUMATOLOGY, 2021, 40 (12) :4807-4815